Provider Demographics
NPI:1114477171
Name:RANCOURT, JENNIFER (BSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:RANCOURT
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:PRESQUE ISLE
Mailing Address - State:ME
Mailing Address - Zip Code:04769-2296
Mailing Address - Country:US
Mailing Address - Phone:207-707-3001
Mailing Address - Fax:207-554-2113
Practice Address - Street 1:11 NORTH ST
Practice Address - Street 2:
Practice Address - City:PRESQUE ISLE
Practice Address - State:ME
Practice Address - Zip Code:04769-2296
Practice Address - Country:US
Practice Address - Phone:207-707-3001
Practice Address - Fax:207-554-2113
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)