Provider Demographics
NPI:1376524546
Name:SPIETH, LESLIE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:E
Last Name:SPIETH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 PLEASANT ST UNIT 220
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-4009
Mailing Address - Country:US
Mailing Address - Phone:207-406-4877
Mailing Address - Fax:
Practice Address - Street 1:10 OCEAN VIEW DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-7922
Practice Address - Country:US
Practice Address - Phone:207-406-4877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-07
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7318103T00000X
ME1578103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1376524546Medicaid