Healthcare Provider Details

I. General information

NPI: 1861641748
Provider Name (Legal Business Name): JOHN LAURENCE LEBOW SR. L.I.C.S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2008
Last Update Date: 06/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S MAIN ST
NEWMARKET NH
03857-1843
US

IV. Provider business mailing address

117 LANGFORD ROAD P.O. BOX 258
CANDIA NH
03034-0303
US

V. Phone/Fax

Practice location:
  • Phone: 603-659-3106
  • Fax: 603-659-8003
Mailing address:
  • Phone: 603-483-5595
  • Fax: 603-483-8933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1419
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: