Provider Demographics
NPI:1336205152
Name:LINDOR, LAURE (PHD)
Entity type:Individual
Prefix:DR
First Name:LAURE
Middle Name:
Last Name:LINDOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-1702
Mailing Address - Country:US
Mailing Address - Phone:617-296-1700
Mailing Address - Fax:617-696-4653
Practice Address - Street 1:1525 BLUE HILL AVE
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-1702
Practice Address - Country:US
Practice Address - Phone:617-296-1700
Practice Address - Fax:617-696-4653
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3902101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1890590Medicaid