Provider Demographics
NPI:1356649107
Name:BLAKEMAN, JODI S (LCPC-C)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:S
Last Name:BLAKEMAN
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CARRIAGE RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-1896
Mailing Address - Country:US
Mailing Address - Phone:207-807-7027
Mailing Address - Fax:
Practice Address - Street 1:5 FUNDY RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1774
Practice Address - Country:US
Practice Address - Phone:207-807-7027
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3756101Y00000X, 101YP2500X
MECC4455101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor