Provider Demographics
NPI:1568910081
Name:ELLERMEYER, LINDSEY J (BA)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:J
Last Name:ELLERMEYER
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:REVERE COMMUNITY COUNSELING
Mailing Address - Street 2:265 BEACH STREET
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151
Mailing Address - Country:US
Mailing Address - Phone:617-724-5600
Mailing Address - Fax:
Practice Address - Street 1:REVERE COMMUNITY COUNSELING
Practice Address - Street 2:265 BEACH STREET
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151
Practice Address - Country:US
Practice Address - Phone:617-724-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program