MEDICARE: CARY JENSON 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	LC7590	ME

General Provider Information

NPI Number	:	1811092190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARY JENSON LCSW

Provider Business Mailing Address
First Line	:	1048 UNION ST., STE 5
Second Line	:
City	:	BANGOR
State	:	ME
Zip	:	04401-0000
Country	:	US
Telephone Number	:	207-945-5247
Fax Number	:	207-992-2154

Provider Business Practice Location Address
First Line	:	1048 UNION ST., STE 5
Second Line	:
City	:	BANGOR
State	:	ME
Zip	:	04401-0000
Country	:	US
Telephone Number	:	207-945-5247
Fax Number	:	207-992-2154

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	07/08/2007

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Directions to “ CARY JENSON LCSW” Practice Location

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