- Practice location
- 57 Exchange St, Suite 403, Portland, ME 04101
- Phone
- 617-431-4608
- Fax
- —
- Last updated
- October 19, 2021
Jennifer H. Bourgoin is a Counselor, Mental Health based in Portland, ME. Jennifer H. Bourgoin practices in Portland, ME and has the professional credentials of PSYD. The NPI Number for Jennifer H. Bourgoin is 1518219302 and holds a License No. PS1620 (ME). The current practice location address for Jennifer H. Bourgoin is 57 Exchange St, Suite 403, Portland, ME 04101 and can be reached out via phone at 617-431-4608.
Provider Profile Details
- NPI Number
- 1518219302
- Provider Name
- Jennifer H. Bourgoin
- Credential
- PSYD
- Provider Entity Type
- Individual
- Gender
- Female
- Address
- 57 Exchange St, Suite 403, Portland, ME 04101
- Phone Number
- 617-431-4608
- Primary Taxonomy
- Counselor, Mental Health · 101YM0800X
- Sole Proprietor
- Yes
- Other Names
- -- Jennifer Tracey Haworth, PSYD (Former Name)
- Provider Enumeration Date
- October 4, 2012
- Last Update Date
- October 19, 2021
- Certification Date
- October 19, 2021
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 57 Exchange St
Suite 403
Portland, ME 04101 - City
- Portland
- State
- Maine
- Zip
- 04101
- Phone Number
- 617-431-4608
Provider Business Mailing Address Details
- Address
- 57 Exchange St
Suite 403
Portland, ME 04101 - City
- Portland
- State
- ME
- Zip
- 04101
- Phone Number
- 617-431-4608
License Information
- License Number (1)
- PS1620
- License State (1)
- ME
- Taxonomy (1)
- Psychologist · 103T00000X
- License Number (2)
- 10275
- License State (2)
- MA
- Taxonomy (2)
- Psychologist · 103T00000X
- License Number (3)
- 024452
- License State (3)
- NY
- Taxonomy (3)
- Psychologist · 103T00000X
- License Number (4)
- 10275
- License State (4)
- MA
- Taxonomy (4)
- Psychologist, Clinical · 103TC0700X
- License Number (5)
- 10275
- License State (5)
- MA
- Taxonomy (5)
- Counselor, Mental Health · 101YM0800X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
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Frequently Asked Questions
What is the NPI number of Dr. Jennifer H Bourgoin, PSYD?
The NPI number of Dr. Jennifer H Bourgoin, PSYD is 1518219302. It was assigned on October 4, 2012 and is currently active in the NPPES registry.
What is the specialty of Dr. Jennifer H Bourgoin, PSYD?
Dr. Jennifer H Bourgoin, PSYD is registered under the primary taxonomy Counselor, Mental Health (code 101YM0800X), licensed in ME under license number PS1620.
Where does Dr. Jennifer H Bourgoin, PSYD practice?
The practice location is 57 Exchange St, Suite 403, Portland, ME 04101. The office can be reached at 617-431-4608 (phone).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1518219302 directly on the NPPES registry website.