Healthcare Provider Details

I. General information

NPI: 1760396428
Provider Name (Legal Business Name): LEAH ELIZABETH MALO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 S HUNTINGTON AVE
BOSTON MA
02130-4817
US

IV. Provider business mailing address

133 WALNUT ST APT 3
SOMERVILLE MA
02145-3082
US

V. Phone/Fax

Practice location:
  • Phone: 617-232-9500
  • Fax:
Mailing address:
  • Phone: 774-319-4223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW231160
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: