Provider Demographics
NPI:1831488873
Name:MEGGISON, JANE IRISH (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:IRISH
Last Name:MEGGISON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1721
Mailing Address - Country:US
Mailing Address - Phone:207-228-5378
Mailing Address - Fax:
Practice Address - Street 1:31 MAIN ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1301
Practice Address - Country:US
Practice Address - Phone:207-228-5378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC19111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical