MEDICARE: MS. SUSAN TURRIFF LEICHTMAN 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
1	1041C0700X	Clinical Social Worker	1023002	MA

General Provider Information

NPI Number	:	1659963544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SUSAN TURRIFF LEICHTMAN LICSW

Provider Business Mailing Address
First Line	:	29 WHITE PINE RD
Second Line	:
City	:	NEWTON UPPER FALLS
State	:	MA
Zip	:	02464-1222
Country	:	US
Telephone Number	:	617-512-3823
Fax Number	:

Provider Business Practice Location Address
First Line	:	29 WHITE PINE RD
Second Line	:
City	:	NEWTON UPPER FALLS
State	:	MA
Zip	:	02464-1222
Country	:	US
Telephone Number	:	617-512-3823
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2021
Last Update Date	:	02/11/2021

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