Provider Demographics
NPI:1225853971
Name:BROWN, JENNIFER ROSE (C-LCPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ROSE
Last Name:BROWN
Suffix:
Gender:F
Credentials:C-LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 PARKVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4062
Mailing Address - Country:US
Mailing Address - Phone:774-330-8742
Mailing Address - Fax:
Practice Address - Street 1:235 CENTER ST
Practice Address - Street 2:
Practice Address - City:BREWER
Practice Address - State:ME
Practice Address - Zip Code:04412-1961
Practice Address - Country:US
Practice Address - Phone:207-561-9496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL7766101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional