Provider Demographics
NPI:1669949111
Name:WEBSTER, JEREMY (CAC)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:WEBSTER
Suffix:
Gender:M
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 HIGH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-1997
Mailing Address - Country:US
Mailing Address - Phone:207-778-3556
Mailing Address - Fax:207-778-3558
Practice Address - Street 1:431 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2100
Practice Address - Country:US
Practice Address - Phone:207-810-4597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC7296101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)