Provider Demographics
NPI:1881823094
Name:PAINE, EMILY M (BS, LGSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:M
Last Name:PAINE
Suffix:
Gender:F
Credentials:BS, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 BELTRAMI AVE NW
Mailing Address - Street 2:PO BOX 430
Mailing Address - City:BEMIDJI
Mailing Address - State:MN
Mailing Address - Zip Code:56601-3010
Mailing Address - Country:US
Mailing Address - Phone:218-444-2845
Mailing Address - Fax:218-444-2847
Practice Address - Street 1:516 BELTRAMI AVE NW
Practice Address - Street 2:
Practice Address - City:BEMIDJI
Practice Address - State:MN
Practice Address - Zip Code:56601-3010
Practice Address - Country:US
Practice Address - Phone:218-444-2845
Practice Address - Fax:218-444-2847
Is Sole Proprietor?:No
Enumeration Date:2009-07-09
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR18958104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker