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General NPI Number Information
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NPI Number | 1023625456
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Entity Type | Individual
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Provider Name | KALEB OAKLEAF LICSW
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Gender | Male
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Dates
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Enumeration Date | 09/29/2020
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Last Update Date | 06/18/2023
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Provider Practice Location Address
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Address Line | 157 FRANKLIN ST APT B5
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City | STONEHAM
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State | MA
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Zip | 02180-1530
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Country | US
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Telephone | 580-747-6348
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Fax |
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Provider Business Mailing Address
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Address Line | 157 FRANKLIN ST APT B5
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City | STONEHAM
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State | MA
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Zip | 02180-1530
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Country | US
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Telephone | 580-747-6348
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 123488
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License Number State | MA
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