Provider Demographics
NPI:1588688535
Name:JONES, LOIS M (LCSW)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:M
Last Name:JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LOIS
Other - Middle Name:R
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:176 FLAGGY MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-2595
Mailing Address - Country:US
Mailing Address - Phone:207-205-5742
Mailing Address - Fax:888-492-0305
Practice Address - Street 1:31 MAIN ST # 3
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1301
Practice Address - Country:US
Practice Address - Phone:207-205-5742
Practice Address - Fax:888-492-0305
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC47991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME275790099Medicaid
MEE300146661Medicare PIN
MEMM5741Medicare PIN