Provider Demographics
NPI:1760132435
Name:SAVAGE, JESSICA (CADC, MHRT/C)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:SAVAGE
Suffix:
Gender:F
Credentials:CADC, MHRT/C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE FALLS
Mailing Address - State:ME
Mailing Address - Zip Code:04254-1529
Mailing Address - Country:US
Mailing Address - Phone:207-320-3305
Mailing Address - Fax:207-645-2372
Practice Address - Street 1:76 MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVERMORE FALLS
Practice Address - State:ME
Practice Address - Zip Code:04254-1529
Practice Address - Country:US
Practice Address - Phone:207-320-3305
Practice Address - Fax:207-645-2372
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-25
Last Update Date:2022-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC8134101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)