Provider Demographics
NPI:1144320532
Name:GETCHELL-DUNN, JEAN MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:GETCHELL-DUNN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 ICHABOD LANE
Mailing Address - Street 2:
Mailing Address - City:HAMPDEN
Mailing Address - State:ME
Mailing Address - Zip Code:04444
Mailing Address - Country:US
Mailing Address - Phone:207-862-5348
Mailing Address - Fax:
Practice Address - Street 1:319 UNION STREET
Practice Address - Street 2:SUITE 5
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401
Practice Address - Country:US
Practice Address - Phone:207-356-7606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC77771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME047969OtherANTHEM