Provider Demographics
NPI:1649463860
Name:LESSARD, MARY-ATALA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY-ATALA
Middle Name:
Last Name:LESSARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 ALLEN AVE.
Mailing Address - Street 2:#20
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103
Mailing Address - Country:US
Mailing Address - Phone:207-749-3829
Mailing Address - Fax:207-872-4522
Practice Address - Street 1:222 ST. JOHN ST.
Practice Address - Street 2:SUITE 16
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102
Practice Address - Country:US
Practice Address - Phone:207-873-2136
Practice Address - Fax:207-872-4522
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC3751101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health