Individual
JENNIFER M TINGLEY PRINCE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
62 ELM ST, PORTLAND, ME 04101-3091
(207) 553-7056
(207) 773-2082
Mailing address
29 FRANKLIN ST, BANGOR, ME 04401-4909
(207) 942-3816
(207) 561-4725
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LC10171
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
098304
ANTHEM LEGACY NUMBER
ME
05
—
431515399
—
ME
Enumeration date
05/31/2006
Last updated
08/28/2009
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