Healthcare Provider Details

I. General information

NPI: 1114087194
Provider Name (Legal Business Name): JENNIFER SUZANNE DORR LSW CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 COMMERCE DR
SKOWHEGAN ME
04976-4823
US

IV. Provider business mailing address

5 COMMERCE DR
SKOWHEGAN ME
04976-4823
US

V. Phone/Fax

Practice location:
  • Phone: 207-474-8311
  • Fax: 207-474-5148
Mailing address:
  • Phone: 207-474-8311
  • Fax: 207-474-5148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberAD3124
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLS9754
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: