Provider Demographics
NPI:1356192454
Name:FARRIN, LESLIE (RDH, MFT)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:FARRIN
Suffix:
Gender:F
Credentials:RDH, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 ICHABOD LANE EXT
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-2744
Mailing Address - Country:US
Mailing Address - Phone:207-310-8272
Mailing Address - Fax:
Practice Address - Street 1:690 STROUDWATER ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4949
Practice Address - Country:US
Practice Address - Phone:207-310-8272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-28
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X
MERDH3557124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Multi-Specialty
No171400000XOther Service ProvidersHealth & Wellness Coach