Provider Demographics
NPI:1902817679
Name:FAHERTY, JENNIFER CONNOR (LCPC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CONNOR
Last Name:FAHERTY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 DAVENPORT CIR #201
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530-2831
Mailing Address - Country:US
Mailing Address - Phone:207-389-6339
Mailing Address - Fax:
Practice Address - Street 1:2 DAVENPORT CIR #201
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530-2831
Practice Address - Country:US
Practice Address - Phone:207-389-6339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3217101YP2500X
ME5567101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional