Provider Demographics
NPI:1811406440
Name:BURLEIGH, LAUREN (LCSW)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BURLEIGH
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:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:ME
Mailing Address - Zip Code:04284-0123
Mailing Address - Country:US
Mailing Address - Phone:207-798-1806
Mailing Address - Fax:888-684-5914
Practice Address - Street 1:22 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:ME
Practice Address - Zip Code:04284-3207
Practice Address - Country:US
Practice Address - Phone:207-798-1806
Practice Address - Fax:888-684-5914
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC180271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical