Individual
TERI LEASURE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
66 BARIBEAU DR, SUITE 8, BRUNSWICK, ME 04011-3230
(207) 373-6971
(207) 373-6959
Mailing address
66 BARIBEAU DR, SUITE 8, BRUNSWICK, ME 04011-3230
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC5720
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102140100
—
ME
Enumeration date
01/26/2007
Last updated
08/03/2009
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