Provider Demographics
NPI:1588111942
Name:WELCH, JESSICA MARIE-MCELRAVY (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MARIE-MCELRAVY
Last Name:WELCH
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 1:12 ELM ST STE 3
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1506
Mailing Address - Country:US
Mailing Address - Phone:207-245-2453
Mailing Address - Fax:
Practice Address - Street 1:12 ELM ST STE 3
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1506
Practice Address - Country:US
Practice Address - Phone:207-245-2453
Practice Address - Fax:207-247-1096
Is Sole Proprietor?:No
Enumeration Date:2016-09-02
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC16236104100000X
MELC182161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker