MEDICARE: JESSICA H CARY MS, RN, CGC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1962668863
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA H CARY MS, RN, CGC

Provider Business Mailing Address
First Line	:	100 CAMPUS DR
Second Line	:	UNIT 108
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-7171
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CAMPUS DR
Second Line	:	UNIT 108
City	:	SCARBOROUGH
State	:	ME
Zip	:	04074-7171
Country	:	US
Telephone Number	:	207-396-8772
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	11/23/2010

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