Provider Demographics
NPI:1306904206
Name:RUHLIN, JENNIFER G (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
Last Name:RUHLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 STATE ST
Mailing Address - Street 2:SUITE 614-615
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5112
Mailing Address - Country:US
Mailing Address - Phone:207-262-4264
Mailing Address - Fax:
Practice Address - Street 1:6 STATE ST
Practice Address - Street 2:SUITE 614-615
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5112
Practice Address - Country:US
Practice Address - Phone:207-262-4264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC 67931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical