Provider Demographics
NPI:1811912603
Name:LEDDY, GERALDINE (LCSW)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:
Last Name:LEDDY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:GERI
Other - Middle Name:
Other - Last Name:LEDDY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:40 RING FARM WEST
Mailing Address - Street 2:
Mailing Address - City:BRIDGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04009
Mailing Address - Country:US
Mailing Address - Phone:207-647-8415
Mailing Address - Fax:207-647-8415
Practice Address - Street 1:40 RING FARM W
Practice Address - Street 2:
Practice Address - City:BRIDGTON
Practice Address - State:ME
Practice Address - Zip Code:04009-4431
Practice Address - Country:US
Practice Address - Phone:207-647-8415
Practice Address - Fax:207-647-8415
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC22771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME0005551173Medicare UPIN
ME011193Medicare UPIN
ME2008896Medicare UPIN
MEMM7676Medicare ID - Type Unspecified