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General NPI Number Information
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NPI Number | 1699315754
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Entity Type | Organization
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Legal Business Name | LESLIE CONNOLLY, P.A.
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 25 MIDDLE ST
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City | PORTLAND
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State | ME
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Zip | 04101-4869
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Country | US
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Telephone | 207-831-9871
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Fax |
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Provider Business Mailing Address
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Address Line | 23 HUNTS POINT RD
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City | CAPE ELIZABETH
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State | ME
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Zip | 04107-2926
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | LESLIE CONNOLLY
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Credential |
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Telephone | 207-831-9871
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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