Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | CAC7377 | ME |
NPI | 1578149654 |
---|---|
Provider Name | Jennifer D Whynot |
First Address | Windham, ME 04062-4520 |
Second Address | Portland, ME 04102-3059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2021 |
Last Update Date | 20/03/2021 |