Jessica N Caraballo, LCPC, CADC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

CC4616 Issued in ME

Practice address

401 Peter Dana Point Rd
Princeton, ME 04668

Phone

(207) 796-2321

NPI assigned

Jun 7, 2010

Last updated

Jul 2, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Indian Township Tribal Government

  dba Passamaquoddy Health Center

  • Federally Qualified Health Center (FQHC)
  • Princeton, ME
  • NPI 1205952140
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1275868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1562025600000",
    "number": "1740500255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 97",
            "city": "PRINCETON",
            "state": "ME",
            "postal_code": "046680097",
            "telephone_number": "207-796-2321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 PETER DANA POINT RD",
            "city": "PRINCETON",
            "state": "ME",
            "postal_code": "04668",
            "telephone_number": "207-796-2321"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARABALLO",
        "first_name": "JESSICA",
        "middle_name": "N",
        "credential": "LCPC, CADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-07",
        "last_updated": "2019-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "ME",
            "license": "CAC6808",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "ME",
            "license": "CC4616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phylicia Joanne Bonavida, NP-C
• Bonnie G Carter
• Anne Cassidy, LPN
• Beth Ann Chabre, NP
• Lawrence Crystal, DPM
• Deborah Lynn Daggett, L.A.D.C

• Mental Health Counselor in Princeton, ME
• Providers in Princeton, ME by specialty
• Mental Health Counselor in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.