Provider Demographics
NPI:1588719256
Name:PAGE, LEE PORTER (MSW MDIV)
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:PORTER
Last Name:PAGE
Suffix:
Gender:F
Credentials:MSW MDIV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:SUNAPEE
Mailing Address - State:NH
Mailing Address - Zip Code:03782
Mailing Address - Country:US
Mailing Address - Phone:603-763-2577
Mailing Address - Fax:603-763-2577
Practice Address - Street 1:154 BROAD ST
Practice Address - Street 2:EMMAUS UNSTITUTE COUNSELING SERVICES
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063
Practice Address - Country:US
Practice Address - Phone:603-886-3760
Practice Address - Fax:603-821-6142
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical