Provider Demographics
NPI:1457965535
Name:CAMPBELL, JINNI-MAE (LMSW-CC)
Entity Type:Individual
Prefix:MRS
First Name:JINNI-MAE
Middle Name:
Last Name:CAMPBELL
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 BAYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096-6134
Mailing Address - Country:US
Mailing Address - Phone:207-391-2298
Mailing Address - Fax:207-871-7457
Practice Address - Street 1:420 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2823
Practice Address - Country:US
Practice Address - Phone:207-871-7431
Practice Address - Fax:207-871-7457
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC190121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical