Provider Demographics
NPI:1790186781
Name:LADD MCAVOY, JOLEEN I (BHP)
Entity Type:Individual
Prefix:
First Name:JOLEEN
Middle Name:
Last Name:LADD MCAVOY
Suffix:I
Gender:F
Credentials:BHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 MILL ST
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1877
Mailing Address - Country:US
Mailing Address - Phone:207-532-6523
Mailing Address - Fax:207-532-3873
Practice Address - Street 1:11 MILL ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-1877
Practice Address - Country:US
Practice Address - Phone:207-532-6523
Practice Address - Fax:207-532-3873
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1790186781Medicaid