Healthcare Provider Details

I. General information

NPI: 1952358905
Provider Name (Legal Business Name): JANET L BEHNKE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 RIVER RD
HIRAM ME
04041-3516
US

IV. Provider business mailing address

11 SUMMIT TER
NORTH YARMOUTH ME
04097-6053
US

V. Phone/Fax

Practice location:
  • Phone: 207-625-3100
  • Fax:
Mailing address:
  • Phone: 207-829-2864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC7253
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: