Provider Demographics
NPI:1346339520
Name:BASS, LEAH (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:BASS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 LEE RD
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-1325
Mailing Address - Country:US
Mailing Address - Phone:617-731-9965
Mailing Address - Fax:617-731-3431
Practice Address - Street 1:1180 BEACON ST
Practice Address - Street 2:4B
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3885
Practice Address - Country:US
Practice Address - Phone:617-731-9965
Practice Address - Fax:617-731-3431
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10210961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP20444Medicare ID - Type Unspecified