Provider Demographics
NPI:1992273387
Name:MOAN, LINDSAY JEAN
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:JEAN
Last Name:MOAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 FOXCROFT DR
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-8735
Mailing Address - Country:US
Mailing Address - Phone:207-560-7564
Mailing Address - Fax:
Practice Address - Street 1:469 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1870
Practice Address - Country:US
Practice Address - Phone:207-490-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC174651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical