| Leslie Connolly, P.a. | |
|
25 Middle St Portland ME 04101-4869 | |
| (207) 831-9871 | |
| Not Available |
| Full Name | Leslie Connolly, P.a. |
|---|---|
| Speciality | Social Worker |
| Location | 25 Middle St, Portland, Maine |
| Authorized Official Name and Position | Leslie Connolly (PROVIDER) |
| Authorized Official Contact | 2078319871 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Leslie Connolly, P.a. 23 Hunts Point Rd Cape Elizabeth ME 04107-2926 Ph: () - | Leslie Connolly, P.a. 25 Middle St Portland ME 04101-4869 Ph: (207) 831-9871 |
| NPI Number | 1699315754 |
|---|---|
| Provider Enumeration Date | 01/07/2020 |
| Last Update Date | 01/07/2020 |
| Certification Date | 01/07/2020 |
| Medicare PECOS PAC ID | 5991132730 |
|---|---|
| Medicare Enrollment ID | O20200217004381 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699315754 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Leslie B Connolly |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1700923448 PECOS PAC ID: 2567555840 Enrollment ID: I20070831000276 |
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