Individual
LESLIE B CONNOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
25 MIDDLE ST, 5, PORTLAND, ME 04101-4869
(207) 831-9871
Mailing address
23 HUNTS POINT RD, CAPE ELIZABETH, ME 04107-2926
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC10877
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274500099
—
ME
Enumeration date
01/31/2007
Last updated
11/18/2016
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