Basic Information
| Provider Information | |||||||||
| NPI: | 1043245947 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CHALOU | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 355 MAHANY RD | ||||||||
| Address2: | P O BOX 404 | ||||||||
| City: | EASTON | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047404345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074886934 | ||||||||
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| Practice Location | |||||||||
| Address1: | 147 ACADEMY STREET | ||||||||
| Address2: | |||||||||
| City: | PRESQUE ISLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077646825 | ||||||||
| FaxNumber: | 2077646077 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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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 | 1041C0700X | LC6260 | ME | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.