Healthcare Provider Details

I. General information

NPI: 1043364151
Provider Name (Legal Business Name): LEIA ZITOLA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 PORTER ST
EAST BOSTON MA
02128-2116
US

IV. Provider business mailing address

118 TEN HILLS RD
SOMERVILLE MA
02145-1033
US

V. Phone/Fax

Practice location:
  • Phone: 617-569-3189
  • Fax: 617-569-7890
Mailing address:
  • Phone: 617-666-3578
  • Fax: 617-569-3516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number211586
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: