Healthcare Provider Details

I. General information

NPI: 1821371287
Provider Name (Legal Business Name): JESSICA HUBLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 01/09/2020
Certification Date: 01/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 TURNER ST
AUBURN ME
04210-5299
US

IV. Provider business mailing address

11 GALEVILLE ST
WINTHROP ME
04364-3554
US

V. Phone/Fax

Practice location:
  • Phone: 207-376-3233
  • Fax:
Mailing address:
  • Phone: 207-931-7459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC18261
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT4652
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: