Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 3820 | MA |
Y | 103T00000X | Psychologist | 3820 | MA |
NPI | 1013015296 |
---|---|
Provider Name | Dr. Leon J Monnin |
First Address | Brockton, MA 02301-4430 |
Second Address | Brockton, MA 02301-4430 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0517496 | (05) | MA |
406936 | TAHP (01) | MA |
W03823 | BCBS (01) | MA |