Healthcare Provider Details

I. General information

NPI: 1811406440
Provider Name (Legal Business Name): LAUREN BURLEIGH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MAIN ST
WAYNE ME
04284-3207
US

IV. Provider business mailing address

PO BOX 123
WAYNE ME
04284-0123
US

V. Phone/Fax

Practice location:
  • Phone: 207-798-1806
  • Fax: 888-684-5914
Mailing address:
  • Phone: 207-798-1806
  • Fax: 888-684-5914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC18027
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: