Provider Demographics
NPI:1831667302
Name:LINDBLOM, PETER E (LCSW)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:E
Last Name:LINDBLOM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MERRILL RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6744
Mailing Address - Country:US
Mailing Address - Phone:781-635-3455
Mailing Address - Fax:
Practice Address - Street 1:8 CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-2158
Practice Address - Country:US
Practice Address - Phone:207-218-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC17615104100000X
MELC193481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker