Provider Demographics
NPI:1306148788
Name:PURCELL, LINNEA JAN (LADC, MSW)
Entity type:Individual
Prefix:MISS
First Name:LINNEA
Middle Name:JAN
Last Name:PURCELL
Suffix:
Gender:F
Credentials:LADC, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-3921
Mailing Address - Country:US
Mailing Address - Phone:207-253-5053
Mailing Address - Fax:
Practice Address - Street 1:24 VERMONT AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-3921
Practice Address - Country:US
Practice Address - Phone:207-253-5053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3915101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)