Healthcare Provider Details

I. General information

NPI: 1578755153
Provider Name (Legal Business Name): LORI LYNNE JEWELL LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 08/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 WATER ST SUITE 2
HOULTON ME
04730-2126
US

IV. Provider business mailing address

PO BOX 4
MONTICELLO ME
04760-0004
US

V. Phone/Fax

Practice location:
  • Phone: 800-580-5510
  • Fax:
Mailing address:
  • Phone: 207-538-0925
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberMC11229
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: