Provider Demographics
NPI:1760637557
Name:BERUBE, JONATHAN (LMFT, CCS, SAP)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:
Last Name:BERUBE
Suffix:
Gender:
Credentials:LMFT, CCS, SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:469 MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SPRINGVALE
Mailing Address - State:ME
Mailing Address - Zip Code:04083-1870
Mailing Address - Country:US
Mailing Address - Phone:207-651-1287
Mailing Address - Fax:207-636-8010
Practice Address - Street 1:469 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1870
Practice Address - Country:US
Practice Address - Phone:207-651-1287
Practice Address - Fax:207-636-8010
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMF4338101YA0400X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)