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1407162779
JACIE SHAW
PORTLAND, ME
NPI
1407162779
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: ME MC12587)
Enumeration Date
2010-08-25
Last Update Date
2010-08-25
Business Address
-- JACIE SHAW
60 BUCA RUN
PORTLAND, ME 04103-1427
Phone number: 204-624-2464
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Mailing Address
-- JACIE SHAW
60 BUCA RUN
PORTLAND, ME 04103-1427
Phone number: 204-624-2464
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