Basic Information
| Provider Information | |||||||||
| NPI: | 1518369370 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SYLVAIN | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | LCSW, LADC, MHRT-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 67 EUSTIS PKWY | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049015173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078732136 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 67 EUSTIS PKWY | ||||||||
| Address2: | |||||||||
| City: | WATERVILLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 049015173 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2078732136 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2014 | ||||||||
| LastUpdateDate: | 08/25/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | LC14380 | ME | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | LC14380 | ME | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | LC14380 | ME | N | Behavioral Health & Social Service Providers | Counselor | Professional | 104100000X | LC14380 | ME | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | LC14380 | ME | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 101YA0400X | LC14380 | ME | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041S0200X | LC14380 | ME | N | Behavioral Health & Social Service Providers | Social Worker | School |
No ID Information.