Healthcare Provider Details

I. General information

NPI: 1245355734
Provider Name (Legal Business Name): LINDA S BROWN LCSW, CCS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 03/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 PORTLAND RD STE 2
KENNEBUNK ME
04043-6651
US

IV. Provider business mailing address

PO BOX 1191 58 PORTLAND ROAD, 2ND FLOOR SUITE
KENNEBUNK ME
04043-1191
US

V. Phone/Fax

Practice location:
  • Phone: 207-841-9069
  • Fax: 207-571-4311
Mailing address:
  • Phone: 207-841-9069
  • Fax: 207-571-4311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC8680
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1063548436
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: