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General NPI Number Information
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NPI Number | 1992344329
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Entity Type | Individual
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Provider Name | JESSICA MEGAN BASALDUA LMSW-CC
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Gender | Female
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Dates
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Enumeration Date | 01/02/2020
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 75 CENTRAL AVE
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City | LEWISTON
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State | ME
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Zip | 04240-6031
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Country | US
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Telephone | 207-795-4180
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Fax | 207-753-6419
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Provider Business Mailing Address
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Address Line | 101 EAST AVE
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City | LEWISTON
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State | ME
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Zip | 04240-5662
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Country | US
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Telephone | 207-777-3399
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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 | CAC6933
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MC20649
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License Number State | ME
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