Provider Demographics
NPI:1548225311
Name:MESERVE, GENEVA LYNN (LCPC)
Entity Type:Individual
Prefix:MS
First Name:GENEVA
Middle Name:LYNN
Last Name:MESERVE
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 1:93 WESTBROOK ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5233
Mailing Address - Country:US
Mailing Address - Phone:207-772-5671
Mailing Address - Fax:
Practice Address - Street 1:636 US ROUTE 1
Practice Address - Street 2:
Practice Address - City:SCARBOROUGH
Practice Address - State:ME
Practice Address - Zip Code:04074-9700
Practice Address - Country:US
Practice Address - Phone:207-408-6670
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2314101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME022806OtherANTHEM BLUE CROSS