Provider Demographics
NPI:1417926163
Name:EAGLES, JANE (LCPC)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:EAGLES
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:DR
Other - First Name:JANE
Other - Middle Name:VAN HANDEL
Other - Last Name:EAGLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MED, PHD
Mailing Address - Street 1:54 MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04849-4008
Mailing Address - Country:US
Mailing Address - Phone:207-548-2440
Mailing Address - Fax:207-548-2476
Practice Address - Street 1:24 MORTLAND ROAD
Practice Address - Street 2:
Practice Address - City:SEARSPORT
Practice Address - State:ME
Practice Address - Zip Code:04974
Practice Address - Country:US
Practice Address - Phone:207-548-2440
Practice Address - Fax:207-548-2476
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2118101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME302720099Medicaid