Provider Demographics
NPI:1760500136
Name:ALLEN, LINDA S (MSW)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1664
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1664
Mailing Address - Country:US
Mailing Address - Phone:207-947-1353
Mailing Address - Fax:
Practice Address - Street 1:1011 BUCK HILL DR
Practice Address - Street 2:
Practice Address - City:VEAZIE
Practice Address - State:ME
Practice Address - Zip Code:04401-7009
Practice Address - Country:US
Practice Address - Phone:207-947-1353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC1515101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health