Individual
MRS. ELLEN MARIE JACKSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
3 FUNDY RD, FALMOUTH, ME 04105-1796
(207) 780-9966
Mailing address
3 FUNDY RD, FALMOUTH, ME 04105-1796
(207) 780-9966
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC1392
ME
Other
Enumeration date
01/03/2007
Last updated
06/14/2010
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