Provider Demographics
NPI:1285470641
Name:TAYLOR, JAY (LSW)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:TAYLOR
Other - Last Name:LINDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:100 GANNETT DR STE C
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5900
Mailing Address - Country:US
Mailing Address - Phone:207-828-0361
Mailing Address - Fax:
Practice Address - Street 1:84 MARGINAL WAY STE 700
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2481
Practice Address - Country:US
Practice Address - Phone:207-347-2674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-05
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELS20905104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker