Provider Demographics
NPI:1275552150
Name:PARENT, JENNIFER LOUISE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LOUISE
Last Name:PARENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LOUISE
Other - Last Name:LEITCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:736 OLD LEWISTON RD
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-4121
Mailing Address - Country:US
Mailing Address - Phone:207-377-8122
Mailing Address - Fax:207-377-8564
Practice Address - Street 1:736 OLD LEWISTON RD
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-4121
Practice Address - Country:US
Practice Address - Phone:207-377-8122
Practice Address - Fax:207-377-8564
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0134902084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME278450099Medicaid
E27581Medicare UPIN
MEMM4581Medicare ID - Type Unspecified