Provider Demographics
NPI:1649611971
Name:BARON, JENIFER LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:JENIFER
Middle Name:LYNN
Last Name:BARON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:LYNN
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:25A JUNE ST
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04073-2642
Mailing Address - Country:US
Mailing Address - Phone:207-490-7998
Mailing Address - Fax:207-490-7999
Practice Address - Street 1:25A JUNE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:ME
Practice Address - Zip Code:04073-2642
Practice Address - Country:US
Practice Address - Phone:207-490-7998
Practice Address - Fax:207-490-7999
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC156121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical