Healthcare Provider Details

I. General information

NPI: 1376611459
Provider Name (Legal Business Name): MR. LEROY ADAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 MASSACHUSETTS AVENUE
BOSTON MA
02118
US

IV. Provider business mailing address

1010 MASSACHUSETTS AVENUE
BOSTON MA
02118
US

V. Phone/Fax

Practice location:
  • Phone: 617-534-4212
  • Fax: 617-534-4221
Mailing address:
  • Phone: 617-534-4212
  • Fax: 617-534-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC7087
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: