Provider Demographics
NPI:1972650190
Name:EDWARDS, JEANNE JOSSELYN (MS)
Entity Type:Individual
Prefix:MRS
First Name:JEANNE
Middle Name:JOSSELYN
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2165 US HWY 1 STE 5
Mailing Address - Street 2:
Mailing Address - City:SULLIVAN
Mailing Address - State:ME
Mailing Address - Zip Code:04664-3215
Mailing Address - Country:US
Mailing Address - Phone:207-422-3428
Mailing Address - Fax:207-422-3428
Practice Address - Street 1:2165 US HWY 1 STE 5
Practice Address - Street 2:
Practice Address - City:SULLIVAN
Practice Address - State:ME
Practice Address - Zip Code:04664-3215
Practice Address - Country:US
Practice Address - Phone:207-422-3428
Practice Address - Fax:207-422-3428
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME7730040OtherAETNA
ME027116OtherANTHEM BLUE CROSS