Provider Demographics
NPI:1376584805
Name:DORLAND, JEANNE M (PHD)
Entity Type:Individual
Prefix:
First Name:JEANNE
Middle Name:M
Last Name:DORLAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 COLUMBIA ST
Mailing Address - Street 2:SUITE301
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-6357
Mailing Address - Country:US
Mailing Address - Phone:207-942-8200
Mailing Address - Fax:207-990-3065
Practice Address - Street 1:82 COLUMBIA ST
Practice Address - Street 2:SUITE301
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6357
Practice Address - Country:US
Practice Address - Phone:207-942-8200
Practice Address - Fax:207-990-3065
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2537101YP2500X
MEPS1240103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431511499Medicaid
ME098304OtherANTHEM LEGACY NUMBER