Provider Demographics
NPI:1639916588
Name:LEEPER, DANA E (LMSW-CC)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:E
Last Name:LEEPER
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-7451
Mailing Address - Country:US
Mailing Address - Phone:207-621-3750
Mailing Address - Fax:
Practice Address - Street 1:9 GREEN ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-7451
Practice Address - Country:US
Practice Address - Phone:207-621-3750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC23632104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker