Provider Demographics
NPI:1225204134
Name:WEARY, JESSICA N (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:WEARY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 SUMMIT SPRING RD
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04274
Mailing Address - Country:US
Mailing Address - Phone:207-310-0026
Mailing Address - Fax:207-998-2232
Practice Address - Street 1:1203 MAINE ST.
Practice Address - Street 2:
Practice Address - City:POLAND
Practice Address - State:ME
Practice Address - Zip Code:04274
Practice Address - Country:US
Practice Address - Phone:207-310-0026
Practice Address - Fax:207-998-2232
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC113081041C0700X
LC113081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical