Provider Demographics
NPI:1316950819
Name:STERMER, LYNN GALE (LCSW, RN)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:GALE
Last Name:STERMER
Suffix:
Gender:F
Credentials:LCSW, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2549
Mailing Address - Country:US
Mailing Address - Phone:207-773-3073
Mailing Address - Fax:207-773-3505
Practice Address - Street 1:32 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3912
Practice Address - Country:US
Practice Address - Phone:207-773-3073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC23431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MESTMM6238Medicare ID - Type Unspecified