Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 114803 | MA |
NPI | 1003123928 |
---|---|
Provider Name | Mrs. Leslie Ann Hanratty |
First Address | Leominster, MA 01453-3228 |
Second Address | Leominster, MA 01453-3228 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2010 |
Last Update Date | 13/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
114803 | DIVISION OF PROFESSIONAL LICENSURE (01) | MA |