Provider Demographics
NPI:1396936787
Name:GILLEN-WORDEN, JODY (NONE) (LCSW)
Entity type:Individual
Prefix:MS
First Name:JODY
Middle Name:(NONE)
Last Name:GILLEN-WORDEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 NORTH ST
Mailing Address - Street 2:APT 2
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-3347
Mailing Address - Country:US
Mailing Address - Phone:207-667-2288
Mailing Address - Fax:
Practice Address - Street 1:58 NORTH ST
Practice Address - Street 2:APT 2
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-3347
Practice Address - Country:US
Practice Address - Phone:207-667-2288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-09
Last Update Date:2007-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4672101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health