Provider Demographics
NPI:1275735318
Name:PLYMALE, FRANKIE EATON (LCSW)
Entity Type:Individual
Prefix:
First Name:FRANKIE
Middle Name:EATON
Last Name:PLYMALE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:FRANKIE
Other - Middle Name:JEAN
Other - Last Name:EATON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 EMERY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-3731
Mailing Address - Country:US
Mailing Address - Phone:207-774-6814
Mailing Address - Fax:
Practice Address - Street 1:121 EMERY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-3731
Practice Address - Country:US
Practice Address - Phone:207-774-6814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3573101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME010718OtherPROVIDER FOR ANTHEM BLUE
ME010718OtherPROVIDER FOR ANTHEM BLUE