Healthcare Provider Details

I. General information

NPI: 1700889482
Provider Name (Legal Business Name): CATHERINE LEE WEISBROD LICSW,CEAP,BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 06/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 ALLSTON ST
CAMBRIDGE MA
02139-3917
US

IV. Provider business mailing address

203 ALLSTON ST
CAMBRIDGE MA
02139-3917
US

V. Phone/Fax

Practice location:
  • Phone: 617-492-3868
  • Fax: 617-547-7304
Mailing address:
  • Phone: 617-492-3868
  • Fax: 617-547-7304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103439
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: