Provider Demographics
NPI:1528736170
Name:OPPENHEIM, JAYMIE ELISABETH (LCSW)
Entity type:Individual
Prefix:
First Name:JAYMIE
Middle Name:ELISABETH
Last Name:OPPENHEIM
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 1:11 LEDGE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5132
Mailing Address - Country:US
Mailing Address - Phone:203-979-0888
Mailing Address - Fax:
Practice Address - Street 1:11 LEDGE RD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5132
Practice Address - Country:US
Practice Address - Phone:203-979-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-31
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA987111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical