Provider Demographics
NPI:1508291832
Name:AGREN, LEAH (LMSW-CC)
Entity Type:Individual
Prefix:MISS
First Name:LEAH
Middle Name:
Last Name:AGREN
Suffix:
Gender:F
Credentials:LMSW-CC
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 746
Mailing Address - Street 2:
Mailing Address - City:BINGHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04920-0746
Mailing Address - Country:US
Mailing Address - Phone:207-672-4187
Mailing Address - Fax:207-672-3641
Practice Address - Street 1:237 MAIN ST
Practice Address - Street 2:
Practice Address - City:BINGHAM
Practice Address - State:ME
Practice Address - Zip Code:04920-4015
Practice Address - Country:US
Practice Address - Phone:207-672-4187
Practice Address - Fax:207-672-3641
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-05
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC14285104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker