Healthcare Provider Details

I. General information

NPI: 1760132435
Provider Name (Legal Business Name): JESSICA SAVAGE CADC, MHRT/C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2022
Last Update Date: 06/25/2022
Certification Date: 06/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

76 MAIN ST
LIVERMORE FALLS ME
04254-1529
US

IV. Provider business mailing address

76 MAIN ST
LIVERMORE FALLS ME
04254-1529
US

V. Phone/Fax

Practice location:
  • Phone: 207-320-3305
  • Fax: 207-645-2372
Mailing address:
  • Phone: 207-320-3305
  • Fax: 207-645-2372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCAC8134
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: