Healthcare Provider Details

I. General information

NPI: 1275981672
Provider Name (Legal Business Name): ASHLEY DAWN LEGASSIE LMSW-CC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 EDGEMONT DR
PRESQUE ISLE ME
04769-2036
US

IV. Provider business mailing address

647 MAIN ST STE 14B
CARIBOU ME
04736-4509
US

V. Phone/Fax

Practice location:
  • Phone: 207-764-3319
  • Fax: 207-768-5377
Mailing address:
  • Phone: 207-492-3009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberMC15539
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: