Healthcare Provider Details

I. General information

NPI: 1922252147
Provider Name (Legal Business Name): JILL ELLEN SHAPIRO LLC/C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 WASHINGTON AVE
PORTLAND ME
04103-2737
US

IV. Provider business mailing address

899 RIVERSIDE ST
PORTLAND ME
04103-1070
US

V. Phone/Fax

Practice location:
  • Phone: 207-776-5637
  • Fax: 207-871-1237
Mailing address:
  • Phone: 207-871-1200
  • Fax: 207-871-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC3744
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: