Provider Demographics
NPI:1316247240
Name:LEIGHTON, CHRISTINE BEA (LSW)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:BEA
Last Name:LEIGHTON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 HANCOCK ST.
Mailing Address - Street 2:SUITE 2C
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401
Mailing Address - Country:US
Mailing Address - Phone:207-989-5701
Mailing Address - Fax:207-989-5720
Practice Address - Street 1:304 HANCOCK ST
Practice Address - Street 2:SUITE 2C
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-6573
Practice Address - Country:US
Practice Address - Phone:207-989-5701
Practice Address - Fax:207-989-5720
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELS10842104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker