Provider Demographics
NPI:1073960753
Name:TINER, JEFF (LCSW)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:
Last Name:TINER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 CONGRESS ST
Mailing Address - Street 2:PO BOX 10660
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3638
Mailing Address - Country:US
Mailing Address - Phone:207-781-8550
Mailing Address - Fax:
Practice Address - Street 1:66 STATE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3751
Practice Address - Country:US
Practice Address - Phone:207-781-8550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME7449-LC1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical