Healthcare Provider Details

I. General information

NPI: 1588111942
Provider Name (Legal Business Name): JESSICA MARIE-MCELRAVY WELCH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 SOKOKIS TRL N STE 4A
LIMERICK ME
04048-3368
US

IV. Provider business mailing address

26 SOKOKIS TRL N STE 4A
LIMERICK ME
04048-3368
US

V. Phone/Fax

Practice location:
  • Phone: 207-245-2453
  • Fax: 207-247-1096
Mailing address:
  • Phone: 207-245-2453
  • Fax: 207-247-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC18216
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: