Provider Demographics
NPI:1851331482
Name:COWAN, JESSICA ADRIANCE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:ADRIANCE
Last Name:COWAN
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 1:30 PINE ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6213
Mailing Address - Country:US
Mailing Address - Phone:707-272-2172
Mailing Address - Fax:
Practice Address - Street 1:30 PINE ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6213
Practice Address - Country:US
Practice Address - Phone:707-272-2172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW264331041C0700X
ME196081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical