Provider Demographics
NPI:1649390915
Name:JALBERT, MAYNARD L (LCPC)
Entity Type:Individual
Prefix:
First Name:MAYNARD
Middle Name:L
Last Name:JALBERT
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 BURLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-2509
Mailing Address - Country:US
Mailing Address - Phone:207-944-6297
Mailing Address - Fax:
Practice Address - Street 1:157 PARK ST STE 22
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5094
Practice Address - Country:US
Practice Address - Phone:207-944-7645
Practice Address - Fax:207-941-8020
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3351101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional