Provider Demographics
NPI:1063477313
Name:THOMPSON MCKINLEY, JEAN A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:A
Last Name:THOMPSON MCKINLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:A
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:526 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAMARISCOTTA
Mailing Address - State:ME
Mailing Address - Zip Code:04543-4680
Mailing Address - Country:US
Mailing Address - Phone:207-776-1518
Mailing Address - Fax:
Practice Address - Street 1:526 MAIN ST
Practice Address - Street 2:
Practice Address - City:DAMARISCOTTA
Practice Address - State:ME
Practice Address - Zip Code:04543-4680
Practice Address - Country:US
Practice Address - Phone:207-776-1518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC89891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEME1334Medicare ID - Type Unspecified