Provider Demographics
NPI:1861593451
Name:LEPAGE, JOAN CAROL (LMHC)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:CAROL
Last Name:LEPAGE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 ASH ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-2130
Mailing Address - Country:US
Mailing Address - Phone:978-632-6467
Mailing Address - Fax:
Practice Address - Street 1:486 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3011
Practice Address - Country:US
Practice Address - Phone:978-630-3225
Practice Address - Fax:978-630-3226
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5196101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA410004OtherMAGELLAN
MA5696210OtherAETNA
MALM0900OtherBLUE CROSS BLUE SHIELD
MA1032300OtherFALLON/BEACON
MA014634OtherHARVARD PILGRIM
MA2174250OtherCIGNA
MA1894501Medicaid
MA460405OtherTUFTS
MA972327OtherNETWORK