Individual
JACQUELINE ROBERGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW-CC
Contact information
Practice address
594 CONGRESS ST, PORTLAND, ME 04101
(207) 588-1043
Mailing address
594 CONGRESS ST, PORTLAND, ME 04101-3352
(603) 833-6318
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
MC15840
ME
171M00000X
Case Manager/Care Coordinator
—
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
99003227
—
NH
Enumeration date
10/02/2012
Last updated
08/05/2019
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