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NPI Code Detail

MEDICARE: MS. LEAH SMITH MARINAKIS LICSW

MEDICARE: MS. LEAH SMITH MARINAKIS LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker123176MA

General Provider Information

NPI Number : 1528448164
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LEAH SMITH MARINAKIS LICSW
Provider Business Mailing Address
First Line : 4 LOVETT ST APT 3
Second Line :
City : BEVERLY
State : MA
Zip : 01915-5297
Country : US
Telephone Number : 781-439-3005
Fax Number :
Provider Business Practice Location Address
First Line : 3 BLACKBURN CTR
Second Line :
City : GLOUCESTER
State : MA
Zip : 01930-2268
Country : US
Telephone Number : 978-283-7198
Fax Number : 978-281-7793
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2015
Last Update Date : 07/18/2022

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