Basic Information
| Provider Information | |||||||||
| NPI: | 1013398197 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WORM | ||||||||
| FirstName: | LINDSEY | ||||||||
| MiddleName: | RENEE | ||||||||
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| Credential: | LCSW-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1113 HEALTHWAY DRIVE | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218044470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103346961 | ||||||||
| FaxNumber: | 4103346362 | ||||||||
| Practice Location | |||||||||
| Address1: | 29520 CANVASBACK DR | ||||||||
| Address2: | |||||||||
| City: | EASTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 216017124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108225007 | ||||||||
| FaxNumber: | 4108225569 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2015 | ||||||||
| LastUpdateDate: | 09/05/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 19254 | MD | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 19254 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 7840093 | 01 | MD | AETNA | OTHER | 259147-000 | 01 | MD | MAGELLAN BEHAVIORAL HEALTH | OTHER | 609550002 | 05 | MD | MEDICAID | 346646 | 01 | MD | TRICARE/MHN | OTHER | R968 | 01 | MD | BCBS | OTHER |