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General NPI Number Information
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NPI Number | 1902865397
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Entity Type | Individual
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Provider Name | JENNIFER WARREN GREAVES L.C.S.W., L.A.D.C.
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Gender | Female
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Dates
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Enumeration Date | 03/22/2006
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Last Update Date | 06/25/2019
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Provider Practice Location Address
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Address Line | 106 SKYLARK RD
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City | PORTLAND
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State | ME
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Zip | 04103-2082
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Country | US
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Telephone | 207-831-2580
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Fax | 207-221-2957
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Provider Business Mailing Address
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Address Line | 95 PARKER ST STE 5
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City | NEWBURYPORT
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State | MA
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Zip | 01950-4034
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Country | US
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Telephone | 207-773-3300
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Fax |
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | LC1990
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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 | LC2965
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License Number State | ME
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