MEDICARE: JJL PSYCHIATRIC COLLECTIVE LLC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1518801364
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JJL PSYCHIATRIC COLLECTIVE LLC

Provider Business Mailing Address
First Line	:	18 NATICK ST
Second Line	:
City	:	PEAKS ISLAND
State	:	ME
Zip	:	04108-1117
Country	:	US
Telephone Number	:	207-329-7771
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 MY WAY
Second Line	:
City	:	WEST BATH
State	:	ME
Zip	:	04530-6483
Country	:	US
Telephone Number	:	207-208-0331
Fax Number	:

Authorized Official
Title or Position	:	PSYCHIATRIC NP
Name	:	LORI M NICHOLAS
Credential	:	PMHNP
Telephone Number	:	207-329-7771

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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