Provider Demographics
NPI:1477919561
Name:FALCONER, JESSICA K (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:K
Last Name:FALCONER
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 1:135 SWAN LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-7035
Mailing Address - Country:US
Mailing Address - Phone:207-322-9987
Mailing Address - Fax:
Practice Address - Street 1:135 SWAN LAKE AVE
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-7035
Practice Address - Country:US
Practice Address - Phone:207-322-9987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-06
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC158611041C0700X
MELC171461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical