Provider Demographics
NPI:1568834281
Name:JANDREAU, JAMIE L (LCSW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:L
Last Name:JANDREAU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:L
Other - Last Name:PARENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:280B GANNETT DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6940
Mailing Address - Country:US
Mailing Address - Phone:207-828-0048
Mailing Address - Fax:207-756-6228
Practice Address - Street 1:280B GANNETT DR
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6940
Practice Address - Country:US
Practice Address - Phone:207-828-0048
Practice Address - Fax:207-756-6228
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC157011041C0700X
MELC168781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical