Provider Demographics
NPI:1316599194
Name:LEZA M. SARROUF, LICSW,LLC
Entity Type:Organization
Organization Name:LEZA M. SARROUF, LICSW,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEZA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SARROUF
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:617-851-2410
Mailing Address - Street 1:36 SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1801
Mailing Address - Country:US
Mailing Address - Phone:617-851-2410
Mailing Address - Fax:
Practice Address - Street 1:7 MYSTIC ST STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-1136
Practice Address - Country:US
Practice Address - Phone:617-600-8760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty