Provider Demographics
NPI:1083080253
Name:TEVARI, LEONA (LMHC)
Entity Type:Individual
Prefix:
First Name:LEONA
Middle Name:
Last Name:TEVARI
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 MASSACHUSETTS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02474-6733
Mailing Address - Country:US
Mailing Address - Phone:781-708-4960
Mailing Address - Fax:
Practice Address - Street 1:275 MYSTIC AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6301
Practice Address - Country:US
Practice Address - Phone:781-708-4960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-11
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8588101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health