Provider Demographics
NPI:1265472005
Name:MONAHON, LINDA C (PHD)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:C
Last Name:MONAHON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 NEW DAM RD
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03901-2626
Mailing Address - Country:US
Mailing Address - Phone:207-363-6535
Mailing Address - Fax:
Practice Address - Street 1:433 US ROUTE 1
Practice Address - Street 2:COTTAGE PLACE #205
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1659
Practice Address - Country:US
Practice Address - Phone:207-363-6535
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS906103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME026913OtherBLUE CROSS BLUE SHIELD
MAW03261OtherBLUE CROSS BLUE SHIELD
MAW03261Medicare ID - Type Unspecified
MEMM8776Medicare ID - Type Unspecified