Healthcare Provider Details

I. General information

NPI: 1316297187
Provider Name (Legal Business Name): JESSICA ROMANOFF BURTON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JESSICA BRITTING ROMANOFF

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 TANDBERG TRL UNIT 4
WINDHAM ME
04062-6417
US

IV. Provider business mailing address

PO BOX 113
SOUTH WINDHAM ME
04082-0113
US

V. Phone/Fax

Practice location:
  • Phone: 207-671-3553
  • Fax:
Mailing address:
  • Phone: 207-671-3553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCC5183
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: