Provider Demographics
NPI:1154451599
Name:MCGRAW, JENNY L (LSWC)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:L
Last Name:MCGRAW
Suffix:
Gender:F
Credentials:LSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 RIVERSIDE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-1070
Mailing Address - Country:US
Mailing Address - Phone:207-871-1200
Mailing Address - Fax:207-871-1232
Practice Address - Street 1:9 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:ME
Practice Address - Zip Code:04346-5131
Practice Address - Country:US
Practice Address - Phone:207-582-9205
Practice Address - Fax:207-582-9653
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELSX10402104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker