Provider Demographics
NPI:1730558164
Name:BARNES, JENNIE L (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIE
Middle Name:L
Last Name:BARNES
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 1:325 MAIN ST STE 155
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4922
Mailing Address - Country:US
Mailing Address - Phone:207-649-4790
Mailing Address - Fax:844-450-1757
Practice Address - Street 1:325 MAIN ST STE 155
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4922
Practice Address - Country:US
Practice Address - Phone:207-649-4790
Practice Address - Fax:844-450-1757
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC168951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical