Provider Demographics
NPI:1366558694
Name:SQUIERS, LESLIE MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:MARIE
Last Name:SQUIERS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MILL ST
Mailing Address - Street 2:
Mailing Address - City:WALDOBORO
Mailing Address - State:ME
Mailing Address - Zip Code:04572-6013
Mailing Address - Country:US
Mailing Address - Phone:207-380-3779
Mailing Address - Fax:
Practice Address - Street 1:27 MILL ST
Practice Address - Street 2:
Practice Address - City:WALDOBORO
Practice Address - State:ME
Practice Address - Zip Code:04572-6013
Practice Address - Country:US
Practice Address - Phone:207-380-3779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC53991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical