Provider Demographics
NPI:1669418430
Name:UNGER, LYNNE (LCSW)
Entity type:Individual
Prefix:
First Name:LYNNE
Middle Name:
Last Name:UNGER
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 1:345 COTTAGE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3919
Mailing Address - Country:US
Mailing Address - Phone:207-799-9198
Mailing Address - Fax:207-799-5151
Practice Address - Street 1:345 COTTAGE RD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-3919
Practice Address - Country:US
Practice Address - Phone:207-799-9198
Practice Address - Fax:207-799-5151
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC62211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME18285OtherBLUE CROSS BLUE SHIELD
MEPO30913OtherTRICARE
MES15425Medicare UPIN
MEPO30913OtherTRICARE