Provider Demographics
NPI:1043525645
Name:RIFFE, JENNIFER ELLEN (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ELLEN
Last Name:RIFFE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 BEACH ST
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072-2812
Mailing Address - Country:US
Mailing Address - Phone:207-749-5378
Mailing Address - Fax:207-391-3212
Practice Address - Street 1:74 BEACH ST
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-2812
Practice Address - Country:US
Practice Address - Phone:207-749-5378
Practice Address - Fax:207-835-4670
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2018-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC68011041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool