Provider Demographics
NPI:1376082594
Name:LEVESQUE, JAMIE (LICSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 OLIVER ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4839
Mailing Address - Country:US
Mailing Address - Phone:508-241-0144
Mailing Address - Fax:
Practice Address - Street 1:215 SANDWICH RD
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-1637
Practice Address - Country:US
Practice Address - Phone:508-295-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1104971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical