Provider Demographics
NPI:1063568145
Name:SMITH-TAYLOR, LESLIE E (LCSW)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:E
Last Name:SMITH-TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:
Other - Last Name:SMITH-BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:42 SALT MARSH PL
Mailing Address - Street 2:
Mailing Address - City:WOOLWICH
Mailing Address - State:ME
Mailing Address - Zip Code:04579
Mailing Address - Country:US
Mailing Address - Phone:207-443-4408
Mailing Address - Fax:
Practice Address - Street 1:444 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ME
Practice Address - Zip Code:04240
Practice Address - Country:US
Practice Address - Phone:207-837-2566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC50901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME098318OtherANTHEM
ME431803699Medicaid
ME098318OtherANTHEM