Provider Demographics
NPI:1740500255
Name:CARABALLO, JESSICA N (LCPC, CADC)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:N
Last Name:CARABALLO
Suffix:
Gender:F
Credentials:LCPC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:ME
Mailing Address - Zip Code:04668-0097
Mailing Address - Country:US
Mailing Address - Phone:207-796-2321
Mailing Address - Fax:
Practice Address - Street 1:401 PETER DANA POINT RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:ME
Practice Address - Zip Code:04668
Practice Address - Country:US
Practice Address - Phone:207-796-2321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-07
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC6808101YA0400X
MECC4616101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)