=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649411224
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PAULA P LINDSEY LSW-CONDITIONAL
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2009
-----------------------------------------------------
Last Update Date | 03/12/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9 HILLCREST AVE
-----------------------------------------------------
City | RANDOLPH
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04346-5131
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-582-1360
-----------------------------------------------------
Fax | 207-582-4360
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 899 RIVERSIDE ST
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | ME
-----------------------------------------------------
Zip | 04103-1070
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 207-871-1200
-----------------------------------------------------
Fax | 207-871-1232
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | LSX11912
-----------------------------------------------------
License Number State | ME
-----------------------------------------------------