Provider Demographics
NPI:1003964115
Name:STEVENS, JERI W (PHD, LCPC)
Entity Type:Individual
Prefix:DR
First Name:JERI
Middle Name:W
Last Name:STEVENS
Suffix:
Gender:F
Credentials:PHD, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6658
Mailing Address - Country:US
Mailing Address - Phone:207-872-7558
Mailing Address - Fax:
Practice Address - Street 1:60 FRONT ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-6658
Practice Address - Country:US
Practice Address - Phone:207-872-7558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2008-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC8101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health