Healthcare Provider Details

I. General information

NPI: 1154946150
Provider Name (Legal Business Name): LEIGH-ANNE HUSTED LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2020
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 PARKER ST STE 306
MAYNARD MA
01754-2180
US

IV. Provider business mailing address

141 PARKER ST STE 306
MAYNARD MA
01754-2180
US

V. Phone/Fax

Practice location:
  • Phone: 215-641-2525
  • Fax: 215-641-2313
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number8877168-3501
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW17259
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: