Individual
JILL ELLEN BISHOP AVERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
418 WATER ST, GARDINER, ME 04345-2058
(207) 588-0235
Mailing address
418 WATER ST, GARDINER, ME 04345-2058
(207) 588-0235
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
LC11640
ME
1041C0700X
Clinical Social Worker
Primary
LC11640
ME
Other
Enumeration date
07/24/2008
Last updated
11/26/2008
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