Provider Demographics
NPI:1528154838
Name:BARNARD, JEANETTE T (LCSW)
Entity type:Individual
Prefix:MS
First Name:JEANETTE
Middle Name:T
Last Name:BARNARD
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 1:45 FOREST FALLS DR
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6999
Mailing Address - Country:US
Mailing Address - Phone:207-846-7755
Mailing Address - Fax:207-846-7756
Practice Address - Street 1:45 FOREST FALLS DR
Practice Address - Street 2:SUITE 2B
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096-6999
Practice Address - Country:US
Practice Address - Phone:207-846-7755
Practice Address - Fax:207-846-7756
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3393101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME7507211OtherAETNA PROVIDER PIN
ME039004OtherANTHEM ID #
ME7507211OtherAETNA PROVIDER PIN