Healthcare Provider Details

I. General information

NPI: 1184739047
Provider Name (Legal Business Name): ALEXANDER G. LEGER-KELLEY MSW-LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 SWEDEN ST
CARIBOU ME
04736-2127
US

IV. Provider business mailing address

43 HATCH DR PO BOX 1018
CARIBOU ME
04736-2161
US

V. Phone/Fax

Practice location:
  • Phone: 207-493-3361
  • Fax: 207-492-4889
Mailing address:
  • Phone: 207-498-6431
  • Fax: 207-492-3181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC8303
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: