Provider Demographics
NPI:1225261852
Name:DESCHENE, JEAN MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:MARIE
Last Name:DESCHENE
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 1:10 GREENWAY ROAD
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-2868
Mailing Address - Country:US
Mailing Address - Phone:978-744-3420
Mailing Address - Fax:978-744-3420
Practice Address - Street 1:10 GREENWAY ROAD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2868
Practice Address - Country:US
Practice Address - Phone:978-744-3420
Practice Address - Fax:978-744-3420
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2009-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA206391104100000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALICENSE # 206391OtherCOMM. OF MA DIVISON OF PROFESSIONAL LICENSURE