Provider Demographics
NPI:1578149654
Name:WHYNOT, JENNIFER D (CADC, CTRS, MHRT-C)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:D
Last Name:WHYNOT
Suffix:
Gender:F
Credentials:CADC, CTRS, MHRT-C
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:D
Other - Last Name:GRANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CADC, CTRS, MHRT-C
Mailing Address - Street 1:29 SWAN RD
Mailing Address - Street 2:
Mailing Address - City:WINDHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04062-4520
Mailing Address - Country:US
Mailing Address - Phone:207-899-7866
Mailing Address - Fax:
Practice Address - Street 1:222 SAINT JOHN ST STE 322
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3059
Practice Address - Country:US
Practice Address - Phone:207-560-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-20
Last Update Date:2021-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC7377103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)