Individual
MS. JACQUELYN CONWAY DODGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
198 MAIN ST, ELLSWORTH, ME 04605-1941
(207) 667-9278
Mailing address
1002 BAYSIDE RD, TRENTON, ME 04605-6513
(207) 667-9278
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1775
ME
Other
Enumeration date
06/13/2007
Last updated
07/08/2007
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