Provider Demographics
NPI:1992344329
Name:BASALDUA, JESSICA MEGAN (LMSW-CC)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:MEGAN
Last Name:BASALDUA
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04240-5662
Mailing Address - Country:US
Mailing Address - Phone:207-777-3399
Mailing Address - Fax:
Practice Address - Street 1:75 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-6031
Practice Address - Country:US
Practice Address - Phone:207-795-4180
Practice Address - Fax:207-753-6419
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-02
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC6933101YA0400X
MEMC20649104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)