Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 1024926 | MA |
NPI | 1003086265 |
---|---|
Provider Name | Mr. Timothy William Leahy |
First Address | Waltham, MA 02451-7521 |
Second Address | Waltham, MA 02451-7521 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2008 |
Last Update Date | 04/03/2008 |