Provider Demographics
NPI:1598849671
Name:JORDAN, SHARON MAE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:MAE
Last Name:JORDAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 PARK ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5000
Mailing Address - Country:US
Mailing Address - Phone:207-992-0411
Mailing Address - Fax:207-907-2048
Practice Address - Street 1:157 PARK ST STE 5
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5000
Practice Address - Country:US
Practice Address - Phone:207-992-0411
Practice Address - Fax:207-907-2048
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC44311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1215102850Medicaid