Provider Demographics
NPI:1750657326
Name:ALEXANDER, JEAN ANN (LMSW-CC)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:ANN
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:MS
Other - First Name:JEAN
Other - Middle Name:ANN
Other - Last Name:ALEXANDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW-CC
Mailing Address - Street 1:168 WOODFORD ST APT 7
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-5629
Mailing Address - Country:US
Mailing Address - Phone:207-939-9260
Mailing Address - Fax:
Practice Address - Street 1:168 WOODFORD ST APT 7
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-5629
Practice Address - Country:US
Practice Address - Phone:207-939-9260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-28
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME#MC12998101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional