Provider Demographics
NPI:1457467052
Name:MANEL JARVIS, DANA ELIZABETH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:ELIZABETH
Last Name:MANEL JARVIS
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 1:22 FREE ST STE 402
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3900
Mailing Address - Country:US
Mailing Address - Phone:207-900-3002
Mailing Address - Fax:
Practice Address - Street 1:22 FREE ST STE 402
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3900
Practice Address - Country:US
Practice Address - Phone:207-900-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC85251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME412190099OtherMAINECARE PROVIDER NUMBER
MELC8525OtherSOCIAL WORK LICENSE #