Provider Demographics
NPI:1235841800
Name:MCDONOUGH, LEAH NICHOLSON (MSW)
Entity Type:Individual
Prefix:MISS
First Name:LEAH
Middle Name:NICHOLSON
Last Name:MCDONOUGH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 BARROWS ST APT 2
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-3068
Mailing Address - Country:US
Mailing Address - Phone:617-692-0416
Mailing Address - Fax:
Practice Address - Street 1:15 BEACON AVE
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-2018
Practice Address - Country:US
Practice Address - Phone:781-769-1342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-15
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical