Provider Demographics
NPI:1720558257
Name:LEBEAU, MARY EDITH
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:EDITH
Last Name:LEBEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 STRAWBERRY HL
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01062-1338
Mailing Address - Country:US
Mailing Address - Phone:203-907-5860
Mailing Address - Fax:
Practice Address - Street 1:35 STRAWBERRY HL
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-1338
Practice Address - Country:US
Practice Address - Phone:203-907-5860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical