=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144399445
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEAH ANN FARLEY LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2006
-----------------------------------------------------
Last Update Date | 08/21/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1D COMMONS DR UNIT 23
-----------------------------------------------------
City | LONDONDERRY
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03053-3433
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-425-7600
-----------------------------------------------------
Fax | 603-425-7605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18 THAIN RD
-----------------------------------------------------
City | HOPKINTON
-----------------------------------------------------
State | NH
-----------------------------------------------------
Zip | 03229-2315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 603-505-0035
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1321
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------