Provider Demographics
NPI:1194850883
Name:LEACH, ALISON K (MA)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:K
Last Name:LEACH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ALISON
Other - Middle Name:K
Other - Last Name:DEMOGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2313 STEARNS HILL RD
Mailing Address - Street 2:
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02451-3350
Mailing Address - Country:US
Mailing Address - Phone:617-939-1019
Mailing Address - Fax:
Practice Address - Street 1:2313 STEARNS HILL RD
Practice Address - Street 2:
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02451-3350
Practice Address - Country:US
Practice Address - Phone:617-939-1019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MA7480101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health