Provider Demographics
NPI:1801971973
Name:LEONE, MARY BETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY BETH
Middle Name:
Last Name:LEONE
Suffix:
Gender:F
Credentials:LCSW
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 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-945-5247
Mailing Address - Fax:
Practice Address - Street 1:53 SCHOODIC DR
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-7246
Practice Address - Country:US
Practice Address - Phone:207-338-6900
Practice Address - Fax:207-338-4976
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC12101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME232690099Medicaid