Provider Demographics
NPI:1457467052
Name:MANEL JARVIS, DANA ELIZABETH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DANA
Middle Name:ELIZABETH
Last Name:MANEL JARVIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 LONG PLAINS RD
Mailing Address - Street 2:
Mailing Address - City:BUXTON
Mailing Address - State:ME
Mailing Address - Zip Code:04093-3208
Mailing Address - Country:US
Mailing Address - Phone:207-929-3836
Mailing Address - Fax:207-929-9152
Practice Address - Street 1:912 LONG PLAINS RD
Practice Address - Street 2:
Practice Address - City:BUXTON
Practice Address - State:ME
Practice Address - Zip Code:04093-3208
Practice Address - Country:US
Practice Address - Phone:207-929-3836
Practice Address - Fax:207-929-9152
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC85251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MELC8525OtherSOCIAL WORK LICENSE #
ME412190099OtherMAINECARE PROVIDER NUMBER