Provider Demographics
NPI:1912221136
Name:WURFEL, JENNIFER L (LADC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:L
Last Name:WURFEL
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 HIGH ST STE 416
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2840
Mailing Address - Country:US
Mailing Address - Phone:207-780-8999
Mailing Address - Fax:207-615-0018
Practice Address - Street 1:142 HIGH ST STE 416
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2840
Practice Address - Country:US
Practice Address - Phone:207-780-8999
Practice Address - Fax:207-615-0018
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC4589101YA0400X
MELC4960101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)