Provider Demographics
NPI:1689607756
Name:LEEMAN, LAWRENCE (LCSW)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:
Last Name:LEEMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 SHAKER RD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-9640
Mailing Address - Country:US
Mailing Address - Phone:207-657-7700
Mailing Address - Fax:207-657-7770
Practice Address - Street 1:67 SHAKER RD
Practice Address - Street 2:SUITE 7
Practice Address - City:GRAY
Practice Address - State:ME
Practice Address - Zip Code:04039-9640
Practice Address - Country:US
Practice Address - Phone:207-657-7700
Practice Address - Fax:207-657-7770
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC84211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME047899Medicare UPIN