Provider Demographics
NPI:1538522628
Name:JACQUES, KAREN (LMSW-CC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:JACQUES
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-6666
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:284 MAIN ST
Practice Address - Street 2:SUITE 390
Practice Address - City:WILTON
Practice Address - State:ME
Practice Address - Zip Code:04294-3044
Practice Address - Country:US
Practice Address - Phone:207-645-5304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC15927101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health