Provider Demographics
NPI:1871005512
Name:LETOURNEAU, LILY
Entity Type:Individual
Prefix:
First Name:LILY
Middle Name:
Last Name:LETOURNEAU
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 1:143A HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6548
Mailing Address - Country:US
Mailing Address - Phone:207-505-0015
Mailing Address - Fax:
Practice Address - Street 1:143A HIGH ST
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6548
Practice Address - Country:US
Practice Address - Phone:207-505-0015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-03
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC190791041C0700X
MEMC16889101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor