Provider Demographics
NPI:1336592484
Name:MINOR, LINDSAY RAE
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:RAE
Last Name:MINOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-6337
Mailing Address - Country:US
Mailing Address - Phone:978-212-9474
Mailing Address - Fax:
Practice Address - Street 1:21 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-6337
Practice Address - Country:US
Practice Address - Phone:978-212-9474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-13
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health