Individual
MRS. STEPHANIE ELAINE JACOBS KISILYWICZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW-C
Contact information
Practice address
304 HANCOCK ST, SUITE 2C, BANGOR, ME 04401-6573
(207) 989-5701
(207) 989-5720
Mailing address
304 HANCOCK ST, SUITE 2C, BANGOR, ME 04401-6573
(207) 989-5701
(207) 989-5720
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
LSX11533
ME
Other
Enumeration date
10/25/2010
Last updated
10/25/2010
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