Healthcare Provider Details

I. General information

NPI: 1558842740
Provider Name (Legal Business Name): LEAH BEIDLER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LEAH BEIDLER LICSW

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 HIGHLAND AVE
SALEM MA
01970-2116
US

IV. Provider business mailing address

159 CONCORD AVE APT 1C
CAMBRIDGE MA
02138-2333
US

V. Phone/Fax

Practice location:
  • Phone: 978-740-1193
  • Fax:
Mailing address:
  • Phone: 802-295-7397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number120908
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: