Jennifer M Crandall, LCSW
Individual provider Active NPI Clinical Social Worker · Caribou, ME
NPI 1073671046 · NPPES record last updated Aug 20, 2014
Key facts
- NPI
- 1073671046
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LC13640 (ME)
- Practice address
- 24 Sweden St
Caribou, ME 04736-2127 - Phone
- (207) 493-3361
- Fax
- (207) 492-4889
- NPI assigned
- Dec 4, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ME
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20121218000447 | ME | Practitioner - Clinical Social Worker | 1153573209 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LC13640 | ME | Yes |
Addresses
Primary practice location
24 Sweden St
Caribou, ME 04736-2127
Mailing address
24 Sweden St
Caribou, ME 04736-2127
Phone (207) 493-3361
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 403910099 | Medicaid | ME |
Other providers in Caribou, ME
- County Optical Inc
- County Physical Therapy, LLC
- Kimberly A Cousins
- Craig K. Small O.D. Family Eye Care
- Chad Crandall
- Cynthia D Currier
- Danyelle Marie Cyr
- Erica M Cyr
- Esther E. Cyr
- Gail M Cyr
All providers in Caribou, ME · Clinical Social Worker in Maine
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 20, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.