Provider Demographics
NPI:1437263688
Name:BORSARI, LEONARD R (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:R
Last Name:BORSARI
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MILLBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WILBRAHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01095-2706
Mailing Address - Country:US
Mailing Address - Phone:413-596-9096
Mailing Address - Fax:413-596-9096
Practice Address - Street 1:4 MILLBROOK DR
Practice Address - Street 2:
Practice Address - City:WILBRAHAM
Practice Address - State:MA
Practice Address - Zip Code:01095-2706
Practice Address - Country:US
Practice Address - Phone:413-596-9096
Practice Address - Fax:413-596-9096
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2209103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA10723OtherHEALTH NEW ENGLAND
MA19387OtherCIGNA
MA725811OtherTUFTS HEALTH PLAN
MAW02381OtherBLUE CROSS/BLUE SHIELD
MA19387OtherCIGNA
MA19387OtherCIGNA