=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477731065
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LESLIE PROULX CUTLER LMCH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/05/2008
-----------------------------------------------------
Last Update Date | 02/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 43 SCHOOSETT ST RTE. 139
-----------------------------------------------------
City | PEMBROKE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02359-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-826-9700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 43 SCHOOSETT ST RTE. 139
-----------------------------------------------------
City | PEMBROKE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02359-1821
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-826-9700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 6095
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------