Jennafer E Soucy, LMSW-CC – Clinical Social Worker

Key facts

NPI: 1265048854
Entity type: Individual (NPI type 1)
Primary specialty: Clinical Social Worker 1041C0700X
License: MC19066 (ME)
Practice address: 50 Moody St
Saco, ME 04072-1536
Phone: (800) 434-3000
Fax: (207) 294-4649
NPI assigned: Sep 18, 2020
Sex: Female
Sole proprietor: No

Medicare participation

Medicare fee-for-service enrollment: Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD): No

State licenses

License	State	Type	Specialty
MC19066	ME	MD	Clinical Social Worker

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Clinical Social Worker	1041C0700X	MC19066	ME	Yes

Addresses

Primary practice location

50 Moody St
Saco, ME 04072-1536

Mailing address

50 Moody St
Saco, ME 04072-1536
Phone (800) 434-3000

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 18, 2020.

{
    "created_epoch": "1600387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600387200000",
    "number": "1265048854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 MOODY ST",
            "city": "SACO",
            "state": "ME",
            "postal_code": "040721536",
            "telephone_number": "800-434-3000",
            "fax_number": "207-294-4649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 MOODY ST",
            "city": "SACO",
            "state": "ME",
            "postal_code": "040721536",
            "telephone_number": "800-434-3000",
            "fax_number": "207-294-4649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUCY",
        "first_name": "JENNAFER",
        "middle_name": "E",
        "credential": "LMSW-CC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-09-18",
        "last_updated": "2020-09-18",
        "certification_date": "2020-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ME",
            "license": "MC19066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saco, ME

All providers in Saco, 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 Sep 18, 2020. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.