Healthcare Provider Details

I. General information

NPI: 1033402458
Provider Name (Legal Business Name): JILLIAN ELIZABETH DUPLISSIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 CENTER ST STE 201
AUBURN ME
04210-5229
US

IV. Provider business mailing address

14 ALLAIN ST
AUBURN ME
04210-4202
US

V. Phone/Fax

Practice location:
  • Phone: 207-777-5888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: