MEDICARE: MR. NATHAN JANOFF LCSW

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
1	1041C0700X	Clinical Social Worker	LC1220	ME

General Provider Information

NPI Number	:	1508907866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NATHAN JANOFF LCSW

Provider Business Mailing Address
First Line	:	1258 WESTBROOK ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04102-1917
Country	:	US
Telephone Number	:	207-956-3723
Fax Number	:	207-899-1351

Provider Business Practice Location Address
First Line	:	1258 WESTBROOK ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04102-1917
Country	:	US
Telephone Number	:	207-956-3723
Fax Number	:	207-899-1351

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	01/23/2015

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