MEDICARE: MS. JANE H. LEAVY MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	104176	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PO2058	OTHER	MA	BLUE CROSS BLUE SHIELD PR

General Provider Information

NPI Number	:	1104979988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANE H. LEAVY MSW

Provider Business Mailing Address
First Line	:	6 FLORAL ST
Second Line	:
City	:	NEWTON HIGHLANDS
State	:	MA
Zip	:	02461-1245
Country	:	US
Telephone Number	:	617-964-6061
Fax Number	:	617-964-1317

Provider Business Practice Location Address
First Line	:	6 FLORAL ST
Second Line	:
City	:	NEWTON HIGHLANDS
State	:	MA
Zip	:	02461-1245
Country	:	US
Telephone Number	:	617-964-6061
Fax Number	:	617-964-1317

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/18/2007
Last Update Date	:	07/08/2007

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