Provider Demographics
NPI:1932318896
Name:TOWN OF LISBON SCHOOL DEPARTMENT
Entity Type:Organization
Organization Name:TOWN OF LISBON SCHOOL DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SPECIAL EDUCATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:207-353-3060
Mailing Address - Street 1:19 GARTLEY ST
Mailing Address - Street 2:
Mailing Address - City:LISBON
Mailing Address - State:ME
Mailing Address - Zip Code:04250-6431
Mailing Address - Country:US
Mailing Address - Phone:207-353-3060
Mailing Address - Fax:207-353-3038
Practice Address - Street 1:19 GARTLEY ST
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:ME
Practice Address - Zip Code:04250-6431
Practice Address - Country:US
Practice Address - Phone:207-353-3060
Practice Address - Fax:207-353-3038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME107620000Medicaid