Provider Demographics
NPI:1972810307
Name:MAILLOUX, JEANNE-MARIE ELISABETH (LICSW)
Entity Type:Individual
Prefix:
First Name:JEANNE-MARIE
Middle Name:ELISABETH
Last Name:MAILLOUX
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 LINCOLN ST APT A
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1938
Mailing Address - Country:US
Mailing Address - Phone:978-399-9286
Mailing Address - Fax:
Practice Address - Street 1:460 LINCOLN ST APT A
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1938
Practice Address - Country:US
Practice Address - Phone:978-206-1495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1196441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical