Provider Demographics
NPI:1114734423
Name:MITSOPOULOS, LYNDSAY (IBCLC)
Entity type:Individual
Prefix:
First Name:LYNDSAY
Middle Name:
Last Name:MITSOPOULOS
Suffix:
Gender:F
Credentials:IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 SPRINGWOOD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-5227
Mailing Address - Country:US
Mailing Address - Phone:603-505-2290
Mailing Address - Fax:
Practice Address - Street 1:60 SPRINGWOOD RD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-5227
Practice Address - Country:US
Practice Address - Phone:603-505-2290
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-11
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN