Provider Demographics
NPI:1043296155
Name:WATSON, LYNN I (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:I
Last Name:WATSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MAIN STREET #104
Mailing Address - Street 2:
Mailing Address - City:SACO
Mailing Address - State:ME
Mailing Address - Zip Code:04072
Mailing Address - Country:US
Mailing Address - Phone:207-205-2560
Mailing Address - Fax:207-284-7861
Practice Address - Street 1:10 MAY ST
Practice Address - Street 2:
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2923
Practice Address - Country:US
Practice Address - Phone:207-205-2560
Practice Address - Fax:207-284-7861
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC82081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME243170099Medicaid
ME30424269Medicaid
MEME0058Medicare PIN
NH30424269Medicaid