Provider Demographics
NPI:1558697722
Name:LEONE, SANDRA MARIE (LCPC, LSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIE
Last Name:LEONE
Suffix:
Gender:F
Credentials:LCPC, LSW
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 646
Mailing Address - Street 2:
Mailing Address - City:SABATTUS
Mailing Address - State:ME
Mailing Address - Zip Code:04280-0646
Mailing Address - Country:US
Mailing Address - Phone:207-478-2657
Mailing Address - Fax:207-947-6747
Practice Address - Street 1:95 MAIN ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5854
Practice Address - Country:US
Practice Address - Phone:207-376-4981
Practice Address - Fax:207-376-4983
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-23
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC3929101YM0800X
MELS9714104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker