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General NPI Number Information
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NPI Number | 1225204134
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Entity Type | Individual
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Provider Name | JESSICA N WEARY LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 04/12/2013
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Provider Practice Location Address
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Address Line | 1203 MAINE ST.
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City | POLAND
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State | ME
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Zip | 04274
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Country | US
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Telephone | 207-310-0026
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Fax | 207-998-2232
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Provider Business Mailing Address
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Address Line | 122 SUMMIT SPRING RD
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City | POLAND
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State | ME
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Zip | 04274
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Country | US
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Telephone | 207-310-0026
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Fax | 207-998-2232
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC11308
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC11308
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License Number State |
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