Provider Demographics
NPI:1376760694
Name:BUCKINGHAM, JENNIFER G (LCPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:G
Last Name:BUCKINGHAM
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2737
Mailing Address - Country:US
Mailing Address - Phone:207-871-1200
Mailing Address - Fax:207-871-1232
Practice Address - Street 1:9 HILLCREST AVE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:ME
Practice Address - Zip Code:04346-5131
Practice Address - Country:US
Practice Address - Phone:207-582-9206
Practice Address - Fax:207-582-9653
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL2989101YP2500X
MECC3528101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional