Provider Demographics
NPI:1326231960
Name:BELKNAP, JACQUELINE ALANA CYGNUS (LCSW)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:ALANA CYGNUS
Last Name:BELKNAP
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:BELKNAP
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:10 MILLS RD STE B
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:ME
Mailing Address - Zip Code:04553-3407
Mailing Address - Country:US
Mailing Address - Phone:207-380-1600
Mailing Address - Fax:
Practice Address - Street 1:10 MILLS RD STE B
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:ME
Practice Address - Zip Code:04553-3407
Practice Address - Country:US
Practice Address - Phone:207-380-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-27
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC95631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432631199Medicaid