Healthcare Provider Details

I. General information

NPI: 1144835604
Provider Name (Legal Business Name): JESSIE MARTEL DUNSON TODD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSIE DUNSON-TODD LCSW

II. Dates (important events)

Enumeration Date: 09/11/2020
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MID COAST DR
BELFAST ME
04915-6079
US

IV. Provider business mailing address

15 MID COAST DR
BELFAST ME
04915-6079
US

V. Phone/Fax

Practice location:
  • Phone: 844-292-0111
  • Fax: 207-338-2388
Mailing address:
  • Phone: 844-292-0111
  • Fax: 207-338-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC21781
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: