MEDICARE: LESLIE F LENNIG LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LC12072	ME

General Provider Information

NPI Number	:	1629384458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE F LENNIG LCSW

Provider Business Mailing Address
First Line	:	24 STONE ST STE 201
Second Line	:
City	:	AUGUSTA
State	:	ME
Zip	:	04330-5209
Country	:	US
Telephone Number	:	207-213-2158
Fax Number	:	207-623-3722

Provider Business Practice Location Address
First Line	:	24 STONE ST STE 201
Second Line	:
City	:	AUGUSTA
State	:	ME
Zip	:	04330-5209
Country	:	US
Telephone Number	:	207-213-2158
Fax Number	:	207-623-3722

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2010
Last Update Date	:	12/02/2019

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