Provider Demographics
NPI:1003955121
Name:CRAMER, LYNDA JEAN (LICSW)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:JEAN
Last Name:CRAMER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:JEAN
Other - Last Name:STOCKBILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2037 WELLESLEY
Mailing Address - Street 2:
Mailing Address - City:ST PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105
Mailing Address - Country:US
Mailing Address - Phone:651-698-7471
Mailing Address - Fax:
Practice Address - Street 1:1885 UNIVERSITY AVE W
Practice Address - Street 2:SUITE 325
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104
Practice Address - Country:US
Practice Address - Phone:651-642-1220
Practice Address - Fax:651-641-4089
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN090191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN7G835CROtherBLUECROSS BLUESHIELD
6245993OtherUNITED BEHAVIORAL
129297OtherCOM PSYCH CORPORATION