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General NPI Number Information
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NPI Number | 1215113808
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Entity Type | Individual
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Provider Name | LEONID NEWHOUSE MSW
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Gender | Male
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Dates
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Enumeration Date | 01/14/2008
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Last Update Date | 09/17/2020
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Provider Practice Location Address
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Address Line | 114 WHITWELL ST
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City | QUINCY
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State | MA
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Zip | 02169-1870
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Country | US
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Telephone | 617-376-5658
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Fax |
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Provider Business Mailing Address
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Address Line | 26 CLIVE ST APT. 3
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City | BOSTON
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State | MA
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Zip | 02130-4430
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Country | US
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Telephone | 617-306-1664
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 1022200
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 1022200
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License Number State | MA
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