1649926338 NPI number — JENNIFER M WEST LCSW, LLC

Table of content: (NPI 1649926338)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649926338 NPI number — JENNIFER M WEST LCSW, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JENNIFER M WEST LCSW, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649926338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
48 HIGH TIDE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNEBUNKPORT
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04046-5430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-229-2398
Provider Business Mailing Address Fax Number:
207-571-3008

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIDDEFORD
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04005-2410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-229-2398
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/22/2022

Additional Information

Authorized Official

Authorized Official Last Name:
WEST
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
207-229-2398

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004652 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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