Provider Demographics
NPI:1386712156
Name:WETTER, DELORES LEAVITT (APRN, BC, LCPC)
Entity type:Individual
Prefix:
First Name:DELORES
Middle Name:LEAVITT
Last Name:WETTER
Suffix:
Gender:F
Credentials:APRN, BC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 STOCK FARM RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PARIS
Mailing Address - State:ME
Mailing Address - Zip Code:04281-6121
Mailing Address - Country:US
Mailing Address - Phone:201-743-9008
Mailing Address - Fax:
Practice Address - Street 1:143 POTTLE RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:ME
Practice Address - Zip Code:04270-3362
Practice Address - Country:US
Practice Address - Phone:207-743-7911
Practice Address - Fax:207-743-7913
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC983101YP2500X
MERO15491364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist