Healthcare Provider Details

I. General information

NPI: 1154442556
Provider Name (Legal Business Name): JEAN RIDINGTON GOLDFINE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 HIGH ST STE 2-2
BELFAST ME
04915-6548
US

IV. Provider business mailing address

143 HIGH ST STE 2-2
BELFAST ME
04915-6548
US

V. Phone/Fax

Practice location:
  • Phone: 207-338-0849
  • Fax:
Mailing address:
  • Phone: 207-338-0849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC4680
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: