Provider Demographics
NPI:1558483982
Name:MERTINKE, JILL (LCPC)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:MERTINKE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 DWELLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:EAST MACHIAS
Mailing Address - State:ME
Mailing Address - Zip Code:04630-4003
Mailing Address - Country:US
Mailing Address - Phone:207-263-9444
Mailing Address - Fax:
Practice Address - Street 1:25 MAIN STREET
Practice Address - Street 2:SUITE #5
Practice Address - City:MACHIAS
Practice Address - State:ME
Practice Address - Zip Code:04654
Practice Address - Country:US
Practice Address - Phone:207-255-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-05
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2367101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME7136870OtherAETNA
ME100535OtherBCBS
ME542081155OtherHARVARD PILGRIM