Provider Demographics
NPI:1255536397
Name:HAWES, JEFFREY MARTIN
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MARTIN
Last Name:HAWES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 GANNETT DRIVE, SUITE 300
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-771-5711
Mailing Address - Fax:207-771-5755
Practice Address - Street 1:35 WESTMINSTER STREET, SUITE B
Practice Address - Street 2:
Practice Address - City:LERVISTM
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-786-8122
Practice Address - Fax:207-786-8164
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC56531041C0700X
MEMC 5653104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical