=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023886868
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHELSEA LYNN BURGE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2023
-----------------------------------------------------
Last Update Date | 01/06/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 LEAVITT ST
-----------------------------------------------------
City | SKOWHEGAN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04976-1843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-446-2347
-----------------------------------------------------
Fax | 844-331-2315
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 LEAVITT ST
-----------------------------------------------------
City | SKOWHEGAN
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04976-1843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-446-2347
-----------------------------------------------------
Fax | 844-331-2315
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LC25605
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------