Provider Demographics
NPI:1912176405
Name:LOOK, JANE A (LCPC CADC)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:A
Last Name:LOOK
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:BOX 12
Mailing Address - Street 2:261 MAIN ST
Mailing Address - City:YARMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04096
Mailing Address - Country:US
Mailing Address - Phone:207-251-1482
Mailing Address - Fax:
Practice Address - Street 1:261 MAIN ST
Practice Address - Street 2:
Practice Address - City:YARMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04096
Practice Address - Country:US
Practice Address - Phone:207-251-1482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-28
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL3316101Y00000X
MECC3822101Y00000X
MECAC4124101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1912176405-001Medicaid