Provider Demographics
NPI:1245355734
Name:BROWN, LINDA S (LCSW, CCS)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:S
Last Name:BROWN
Suffix:
Gender:F
Credentials:LCSW, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1191
Mailing Address - Street 2:58 PORTLAND ROAD, 2ND FLOOR SUITE
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-1191
Mailing Address - Country:US
Mailing Address - Phone:207-841-9069
Mailing Address - Fax:207-571-4311
Practice Address - Street 1:58 PORTLAND RD STE 2
Practice Address - Street 2:
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-6651
Practice Address - Country:US
Practice Address - Phone:207-841-9069
Practice Address - Fax:207-571-4311
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC86801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1063548436Medicaid