Provider Demographics
NPI:1265867451
Name:MEAD, ELSA R (LCSW)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:R
Last Name:MEAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELSA
Other - Middle Name:MARTINEZ
Other - Last Name:VILLEGAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 552
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-0552
Mailing Address - Country:US
Mailing Address - Phone:207-494-4500
Mailing Address - Fax:
Practice Address - Street 1:177 LINCOLNVILLE AVE
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-7402
Practice Address - Country:US
Practice Address - Phone:207-494-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-06
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1265867451OtherNASW