Provider Demographics
NPI:1487622643
Name:LEBEAU, COLLEEN M (LICSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:LEBEAU
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 WARREN ST
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301
Mailing Address - Country:US
Mailing Address - Phone:603-226-1999
Mailing Address - Fax:603-224-1675
Practice Address - Street 1:33 WARREN ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301
Practice Address - Country:US
Practice Address - Phone:603-226-1999
Practice Address - Fax:603-224-1675
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH675104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30010340Medicaid
NHRE5173Medicare ID - Type Unspecified