Provider Demographics
NPI:1508907866
Name:JANOFF, NATHAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:
Last Name:JANOFF
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1258 WESTBROOK ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1917
Mailing Address - Country:US
Mailing Address - Phone:207-956-3723
Mailing Address - Fax:207-899-1351
Practice Address - Street 1:1258 WESTBROOK ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1917
Practice Address - Country:US
Practice Address - Phone:207-956-3723
Practice Address - Fax:207-899-1351
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC12201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400172140Medicare PIN
MEE400115125Medicare PIN