Healthcare Provider Details

I. General information

NPI: 1114852977
Provider Name (Legal Business Name): MICHAELA GREENLEAF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 SAUNDERS WAY STE 700
WESTBROOK ME
04092-4834
US

IV. Provider business mailing address

24 WESTMORE AVE
CUMBERLAND ME
04021-3054
US

V. Phone/Fax

Practice location:
  • Phone: 207-878-9663
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLM26071
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: