Provider Demographics
NPI:1598974156
Name:LUFKIN, LESLIE G (LCSW)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:G
Last Name:LUFKIN
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 1:20 FLAHERTY LN
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:ME
Mailing Address - Zip Code:04217-7020
Mailing Address - Country:US
Mailing Address - Phone:207-357-2520
Mailing Address - Fax:
Practice Address - Street 1:20 FLAHERTY LN
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:ME
Practice Address - Zip Code:04217-7020
Practice Address - Country:US
Practice Address - Phone:207-357-2520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2016-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC1717101YA0400X
MELC54931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME033968OtherBLUE CROSS AND BLUE SHIEL
ME033968OtherBLUE CROSS AND BLUE SHIEL