Provider Demographics
NPI:1396858809
Name:FELDEISEN, JEAN ANNE (LCSW, LADC)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:ANNE
Last Name:FELDEISEN
Suffix:
Gender:F
Credentials:LCSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BRUNSWICK AVENUE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:GARDINER
Mailing Address - State:ME
Mailing Address - Zip Code:04345-2123
Mailing Address - Country:US
Mailing Address - Phone:207-588-0040
Mailing Address - Fax:207-588-0040
Practice Address - Street 1:17 BRUNSWICK AVENUE
Practice Address - Street 2:SUITE 6
Practice Address - City:GARDINER
Practice Address - State:ME
Practice Address - Zip Code:04345-2123
Practice Address - Country:US
Practice Address - Phone:207-588-0040
Practice Address - Fax:207-588-0040
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC2249101YA0400X
MELC80441041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME100374OtherANTHEM
ME305540099Medicaid
ME305540099Medicaid