Provider Demographics
NPI:1649328048
Name:ZEITLIN, PAULA R (LCSW)
Entity type:Individual
Prefix:MS
First Name:PAULA
Middle Name:R
Last Name:ZEITLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 FEDERAL ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-4260
Mailing Address - Country:US
Mailing Address - Phone:207-772-7700
Mailing Address - Fax:207-772-7702
Practice Address - Street 1:69 FEDERAL ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4260
Practice Address - Country:US
Practice Address - Phone:207-772-7700
Practice Address - Fax:207-772-7702
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC63291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM7523Medicare ID - Type Unspecified