Active NPI
Jennifer Queally, LCPC-C
- Professional Counselor
- South Portland, ME
National Provider Identifier
1285176677
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- XL4650
- Practice address
- 60 Chase St
South Portland, ME 04106-3931 - Phone
- (207) 329-3769
- NPI assigned
- Nov 16, 2016
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | XL4650 | ME | Primary |
Addresses
Primary practice location
60 Chase St
South Portland, ME 04106-3931
Mailing address
60 Chase St
South Portland, ME 04106-3931
Phone (207) 329-3769
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| XL4650 | ME | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1479254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1479254400000",
"number": "1285176677",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "60 CHASE ST",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041063931",
"telephone_number": "207-329-3769"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "60 CHASE ST",
"city": "SOUTH PORTLAND",
"state": "ME",
"postal_code": "041063931",
"telephone_number": "207-329-3769"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUEALLY",
"first_name": "JENNIFER",
"credential": "LCPC-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-11-16",
"last_updated": "2016-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "ME",
"license": "XL4650",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Portland, ME
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.