Provider Demographics
NPI:1003452178
Name:LAUREN BURLEIGH LCSW LLC
Entity Type:Organization
Organization Name:LAUREN BURLEIGH LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURLEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:207-798-1806
Mailing Address - Street 1:16 NOBLE ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-2437
Mailing Address - Country:US
Mailing Address - Phone:207-798-1806
Mailing Address - Fax:
Practice Address - Street 1:6 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-1508
Practice Address - Country:US
Practice Address - Phone:207-798-1806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-22
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty