Provider Demographics
NPI:1588891170
Name:STEVENS, JENNIFER LOUISE (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOUISE
Last Name:STEVENS
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:P.O. BOX 304
Mailing Address - Street 2:
Mailing Address - City:NORTH VASSALBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04962
Mailing Address - Country:US
Mailing Address - Phone:207-861-1290
Mailing Address - Fax:207-660-4754
Practice Address - Street 1:237 MAIN STREET
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901
Practice Address - Country:US
Practice Address - Phone:207-861-1290
Practice Address - Fax:207-660-4754
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC121051041C0700X
MELC132021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical