Provider Demographics
NPI:1427257195
Name:MAXWELL, LEAH A (LCSW)
Entity type:Individual
Prefix:MS
First Name:LEAH
Middle Name:A
Last Name:MAXWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:RUFFIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:482 CONGRESS ST STE 301
Mailing Address - Street 2:STEPPING STONES
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-3437
Mailing Address - Country:US
Mailing Address - Phone:888-866-0113
Mailing Address - Fax:207-775-2255
Practice Address - Street 1:6 STATE ST STE 310
Practice Address - Street 2:STEPPING STONES
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5133
Practice Address - Country:US
Practice Address - Phone:888-866-1113
Practice Address - Fax:207-941-8942
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC111601041C0700X
MELC121691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical