Provider Demographics
NPI:1396857991
Name:MEHLDAU, LEIGH ANNE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LEIGH ANNE
Middle Name:
Last Name:MEHLDAU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 OVERHILL DR
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2316
Mailing Address - Country:US
Mailing Address - Phone:860-558-9595
Mailing Address - Fax:
Practice Address - Street 1:933 HARTFORD TPKE
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:CT
Practice Address - Zip Code:06066-4407
Practice Address - Country:US
Practice Address - Phone:860-872-7696
Practice Address - Fax:860-871-0252
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0047261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP2892653OtherOXFORD PROV NUMBER
CT140004726CT04OtherBLUE SHIELD PROV NUMBER