Provider Demographics
NPI:1578755153
Name:JEWELL, LORI LYNNE (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:LYNNE
Last Name:JEWELL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:ME
Mailing Address - Zip Code:04760-0004
Mailing Address - Country:US
Mailing Address - Phone:207-538-0925
Mailing Address - Fax:
Practice Address - Street 1:2 WATER ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-2126
Practice Address - Country:US
Practice Address - Phone:800-580-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC11229104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker