Provider Demographics
NPI:1902347057
Name:DYER, VERONICA LYNN (LADC, CCS)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:LYNN
Last Name:DYER
Suffix:
Gender:F
Credentials:LADC, CCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 242
Mailing Address - Street 2:
Mailing Address - City:EAST WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04343-0242
Mailing Address - Country:US
Mailing Address - Phone:207-242-6458
Mailing Address - Fax:207-203-6222
Practice Address - Street 1:362 ROUTE 133
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364-4021
Practice Address - Country:US
Practice Address - Phone:207-242-6458
Practice Address - Fax:207-203-6222
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-09
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1902347057Medicaid