Healthcare Provider Details

I. General information

NPI: 1760219240
Provider Name (Legal Business Name): BRIANNA MARIE LEON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 GOLD STAR BLVD
WORCESTER MA
01606-2738
US

IV. Provider business mailing address

135 GOLD STAR BLVD
WORCESTER MA
01606-2738
US

V. Phone/Fax

Practice location:
  • Phone: 885-496-8462
  • Fax:
Mailing address:
  • Phone: 508-459-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW2140711
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: