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General NPI Number Information
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NPI Number | 1932607801
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Entity Type | Organization
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Legal Business Name | PORTLAND INSTITUTE FOR PSYCHOTHERAPY AND TRAINING
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Dates
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Enumeration Date | 01/25/2018
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Last Update Date | 07/18/2024
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Provider Practice Location Address
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Address Line | 30 DANFORTH ST STE 311
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City | PORTLAND
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State | ME
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Zip | 04101-4574
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Country | US
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Telephone | 207-619-3356
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Fax | 207-300-6085
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Provider Business Mailing Address
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Address Line | PO BOX 8484
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City | PORTLAND
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State | ME
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Zip | 04104-8484
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Country | US
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Telephone | 207-619-3356
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Fax | 207-300-6085
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | LINDY GRAHAM
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Credential | LCSW
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Telephone | 207-619-3356
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LC10604
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License Number State | ME
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