Provider Demographics
NPI:1508103052
Name:RACINE, JAMIE L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:L
Last Name:RACINE
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 1:28 STATE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1147
Mailing Address - Country:US
Mailing Address - Phone:207-558-2346
Mailing Address - Fax:
Practice Address - Street 1:28 STATE ST STE 5
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1147
Practice Address - Country:US
Practice Address - Phone:207-558-2346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC19743101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health