Provider Demographics
NPI:1003011487
Name:WAKEM, JEAN MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARIE
Last Name:WAKEM
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 1:95 SIROTA DR
Mailing Address - Street 2:
Mailing Address - City:SEARSMONT
Mailing Address - State:ME
Mailing Address - Zip Code:04973-3323
Mailing Address - Country:US
Mailing Address - Phone:207-342-5387
Mailing Address - Fax:
Practice Address - Street 1:253 NORTHPORT AVE
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6006
Practice Address - Country:US
Practice Address - Phone:207-338-4514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC7318101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health