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1992392914
JACOB M WISECUP
PORTLAND, ME
NPI
1992392914
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1041C0700X Social Worker, Clinical
(Licence: ME MC19315)
Enumeration Date
2020-12-23
Last Update Date
2020-12-23
Business Address
JACOB M WISECUP LMSW-CC
901 WASHINGTON AVE STE 100
PORTLAND, ME 04103-2842
Phone number: 207-871-1200
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Mailing Address
JACOB M WISECUP LMSW-CC
901 WASHINGTON AVE STE 100
PORTLAND, ME 04103-2842
Phone number: 207-871-1200
Copy
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