Provider Demographics
NPI:1851429575
Name:NEGOESCU, JONATHAN KEVIN NICHOLAS (LCSW)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:KEVIN NICHOLAS
Last Name:NEGOESCU
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 PORTLAND AVE
Mailing Address - Street 2:UNIT 6
Mailing Address - City:OLD ORCHARD BEACH
Mailing Address - State:ME
Mailing Address - Zip Code:04064-1500
Mailing Address - Country:US
Mailing Address - Phone:207-934-0460
Mailing Address - Fax:
Practice Address - Street 1:209 MAIN ST
Practice Address - Street 2:SUITE 302
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-1566
Practice Address - Country:US
Practice Address - Phone:207-571-9923
Practice Address - Fax:207-571-9927
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC102421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical