Provider Demographics
NPI:1770638678
Name:MCAULIFFE, JANA M
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:M
Last Name:MCAULIFFE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 BOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:SEARSMONT
Mailing Address - State:ME
Mailing Address - Zip Code:04973-3737
Mailing Address - Country:US
Mailing Address - Phone:207-785-3085
Mailing Address - Fax:207-785-2227
Practice Address - Street 1:82 BOROUGH RD
Practice Address - Street 2:
Practice Address - City:SEARSMONT
Practice Address - State:ME
Practice Address - Zip Code:04973-3737
Practice Address - Country:US
Practice Address - Phone:207-785-3085
Practice Address - Fax:207-785-2227
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME68831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME093351Medicare ID - Type Unspecified