Provider Demographics
NPI:1881835007
Name:HOUSE-WORSTER, LESLIE ANN
Entity Type:Individual
Prefix:MS
First Name:LESLIE
Middle Name:ANN
Last Name:HOUSE-WORSTER
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:LESLIE
Other - Middle Name:ANN
Other - Last Name:HOUSE-WORSTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADC
Mailing Address - Street 1:PO BOX 958
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-0958
Mailing Address - Country:US
Mailing Address - Phone:207-667-3210
Mailing Address - Fax:207-667-1633
Practice Address - Street 1:8 OLD MILL RD
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-0958
Practice Address - Country:US
Practice Address - Phone:207-667-3210
Practice Address - Fax:207-667-1633
Is Sole Proprietor?:No
Enumeration Date:2009-03-18
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC4059101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME433095599Medicaid