Provider Demographics
NPI:1811046675
Name:PAINE, DONALD LINCOLN (LICSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:LINCOLN
Last Name:PAINE
Suffix:
Gender:M
Credentials:LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 NEW KARNER RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-4617
Mailing Address - Country:US
Mailing Address - Phone:518-452-9919
Mailing Address - Fax:518-452-9919
Practice Address - Street 1:251 NEW KARNER RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-4617
Practice Address - Country:US
Practice Address - Phone:518-452-9919
Practice Address - Fax:518-452-9919
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20113701041C0700X
NYR056435-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY56973BMedicare ID - Type UnspecifiedPROVIDER #