Healthcare Provider Details

I. General information

NPI: 1619293016
Provider Name (Legal Business Name): JESSICA L. GALLANT LMSW-CC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2010
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 MAIN ST 3RD FLOOR
WESTBROOK ME
04092
US

IV. Provider business mailing address

820 MAIN ST 3RD FLOOR
WESTBROOK ME
04092
US

V. Phone/Fax

Practice location:
  • Phone: 207-854-1030
  • Fax: 207-854-1001
Mailing address:
  • Phone: 207-854-1030
  • Fax: 207-854-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLM12052
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: