Provider Demographics
NPI:1811079510
Name:MCPHERSON, JEANIE KAY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JEANIE
Middle Name:KAY
Last Name:MCPHERSON
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:PO BOX 5425
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-5425
Mailing Address - Country:US
Mailing Address - Phone:207-667-2119
Mailing Address - Fax:207-667-7319
Practice Address - Street 1:194 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1939
Practice Address - Country:US
Practice Address - Phone:207-667-2119
Practice Address - Fax:207-667-7319
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC67351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical