Provider Demographics
NPI:1407589641
Name:CORRIVEAU, JESSICA LEE-ANNE (CADC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:LEE-ANNE
Last Name:CORRIVEAU
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 SPEAR ST
Mailing Address - Street 2:
Mailing Address - City:LISBON FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04252-6142
Mailing Address - Country:US
Mailing Address - Phone:207-333-9509
Mailing Address - Fax:
Practice Address - Street 1:101 EAST AVE
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240-5662
Practice Address - Country:US
Practice Address - Phone:207-777-3399
Practice Address - Fax:207-777-3391
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC8031101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)