Provider Demographics
NPI:1124198270
Name:CARROLL, LYNN RAE (LCPC)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:RAE
Last Name:CARROLL
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 SIS PORTER ROAD
Mailing Address - Street 2:
Mailing Address - City:SEDGWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04676
Mailing Address - Country:US
Mailing Address - Phone:207-326-9179
Mailing Address - Fax:
Practice Address - Street 1:415 WATER ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-2116
Practice Address - Country:US
Practice Address - Phone:207-667-5357
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLMHC - 0097841101Y00000X
MECC3486101YM0800X
MELS3891104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM17384265Medicaid