Provider Demographics
NPI:1982183281
Name:LINDBLOM, DUANE (WAIVER)
Entity Type:Individual
Prefix:MR
First Name:DUANE
Middle Name:
Last Name:LINDBLOM
Suffix:
Gender:M
Credentials:WAIVER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:NH
Mailing Address - Zip Code:03818-6044
Mailing Address - Country:US
Mailing Address - Phone:603-447-3905
Mailing Address - Fax:
Practice Address - Street 1:70 BAY ST
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4320
Practice Address - Country:US
Practice Address - Phone:603-356-1884
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2018-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker