=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730674672
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEAH DITTMAN LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2018
-----------------------------------------------------
Last Update Date | 12/21/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26 LYNDE ST # 1A
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01970-3404
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-231-8757
-----------------------------------------------------
Fax | 206-752-8736
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 675 VFW PKWY STE 168
-----------------------------------------------------
City | CHESTNUT HILL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02467-3656
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-231-8757
-----------------------------------------------------
Fax | 206-752-8736
-----------------------------------------------------
=====================================================
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 | 12103
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------