Provider Demographics
NPI:1639226749
Name:JANAK, ANNE KENDALL (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:KENDALL
Last Name:JANAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:ANNE
Other - Middle Name:KATHRYN
Other - Last Name:JANAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:125 PRESUMPSCOT ST
Mailing Address - Street 2:UNIT #9
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5225
Mailing Address - Country:US
Mailing Address - Phone:207-871-1000
Mailing Address - Fax:207-699-4301
Practice Address - Street 1:125 PRESUMPSCOT ST
Practice Address - Street 2:UNIT #9
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5225
Practice Address - Country:US
Practice Address - Phone:207-871-1000
Practice Address - Fax:207-699-4301
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC9747101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0009750OtherMEDICARE PTAN