Individual
DR. JENNIFER H. BOURGOIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
57 EXCHANGE ST, SUITE 403, PORTLAND, ME 04101
(617) 431-4608
Mailing address
57 EXCHANGE ST, SUITE 403, PORTLAND, ME 04101
(617) 431-4608
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
10275
MA
103T00000X
Psychologist
024452
NY
103T00000X
Psychologist
10275
MA
103T00000X
Psychologist
PS1620
ME
103TC0700X
Clinical Psychologist
10275
MA
Other
Enumeration date
10/04/2012
Last updated
10/19/2021
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