Organization
JON PETRUSCHKE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JON PETRUSCHKE (SOCIAL WORKER)
(207) 774-9667
Entity
Organization
Contact information
Practice address
145 NEWBURY ST, SUITE 2, PORTLAND, ME 04101-4261
(207) 774-9667
Mailing address
21 HOWARD ST, PORTLAND, ME 04101-3208
(207) 774-9667
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
04/24/2017
Last updated
04/24/2017
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