Doctor Name: | MS. JAIME MARIE TARDIF |
NPI Number: | 1396963245 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | LC11211 |
Business Practice Address: | 72 Justice Way Gorham, ME - 04038 |
Business Phone Number: | 2072221050 |
Business Fax Number: | |
Mailing Address: | 55 Atlantic Street, Apt. 2 PORTLAND |
State: | ME |
Postal Code: | 041014358 |
Phone Number: | 2078388327 |
Fax Number: | |
NPI Enumeration Date: | 04/23/2007 |
NPI Last Update Date: | 10/06/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LC11211 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ME |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |