=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235613175
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CATHERINE LECLERC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2018
-----------------------------------------------------
Last Update Date | 09/17/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 90 WELLS AVE
-----------------------------------------------------
City | NEWTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02459-3210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-969-6130
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 ROBBINS ST
-----------------------------------------------------
City | ACTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01720-3515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 978-314-4692
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 11667
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------