Provider Demographics
NPI:1932329794
Name:LOOS, JEANNIE LOU (LMSWCC)
Entity Type:Individual
Prefix:MS
First Name:JEANNIE
Middle Name:LOU
Last Name:LOOS
Suffix:
Gender:F
Credentials:LMSWCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 32
Mailing Address - Street 2:KELLEYTOWN RD.
Mailing Address - City:SEAL COVE
Mailing Address - State:ME
Mailing Address - Zip Code:04674-0032
Mailing Address - Country:US
Mailing Address - Phone:207-244-3528
Mailing Address - Fax:
Practice Address - Street 1:204 WATER ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2038
Practice Address - Country:US
Practice Address - Phone:207-667-2061
Practice Address - Fax:207-667-8624
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC8135104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker