Provider Demographics
NPI:1861641748
Name:LEBOW, JOHN LAURENCE SR (LICSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:LAURENCE
Last Name:LEBOW
Suffix:SR
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 LANGFORD ROAD
Mailing Address - Street 2:P.O. BOX 258
Mailing Address - City:CANDIA
Mailing Address - State:NH
Mailing Address - Zip Code:03034-0303
Mailing Address - Country:US
Mailing Address - Phone:603-483-5595
Mailing Address - Fax:603-483-8933
Practice Address - Street 1:207 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWMARKET
Practice Address - State:NH
Practice Address - Zip Code:03857-1843
Practice Address - Country:US
Practice Address - Phone:603-659-3106
Practice Address - Fax:603-659-8003
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3088831Medicaid