MEDICARE: MS. CATHERINE LEE WEISBROD LICSW,CEAP,BCD

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	103439	MA

General Provider Information

NPI Number	:	1700889482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CATHERINE LEE WEISBROD LICSW,CEAP,BCD

Provider Business Mailing Address
First Line	:	203 ALLSTON ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-3917
Country	:	US
Telephone Number	:	617-492-3868
Fax Number	:	617-547-7304

Provider Business Practice Location Address
First Line	:	203 ALLSTON ST
Second Line	:
City	:	CAMBRIDGE
State	:	MA
Zip	:	02139-3917
Country	:	US
Telephone Number	:	617-492-3868
Fax Number	:	617-547-7304

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	06/26/2010

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