Healthcare Provider Details

I. General information

NPI: 1306173182
Provider Name (Legal Business Name): JENNIFER J MADORE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 JO JOY RD
LIMINGTON ME
04049
US

IV. Provider business mailing address

233 JO JOY RD
LIMINGTON ME
04049
US

V. Phone/Fax

Practice location:
  • Phone: 207-579-1417
  • Fax:
Mailing address:
  • Phone: 207-579-1417
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLS10156
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC17855
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: