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NPI Code Detail

MEDICARE: JENNIFER RANCOURT BSW

MEDICARE: JENNIFER RANCOURT BSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1114477171
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER RANCOURT BSW
Provider Business Mailing Address
First Line : 11 NORTH ST
Second Line :
City : PRESQUE ISLE
State : ME
Zip : 04769-2296
Country : US
Telephone Number : 207-707-3001
Fax Number : 207-554-2113
Provider Business Practice Location Address
First Line : 11 NORTH ST
Second Line :
City : PRESQUE ISLE
State : ME
Zip : 04769-2296
Country : US
Telephone Number : 207-707-3001
Fax Number : 207-554-2113
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2016
Last Update Date : 08/12/2021

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