Provider Demographics
NPI:1477626240
Name:PRIESTLEY, LEAH ANNE (MSW)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:ANNE
Last Name:PRIESTLEY
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 1:22 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTON
Mailing Address - State:MA
Mailing Address - Zip Code:01746-2609
Mailing Address - Country:US
Mailing Address - Phone:617-969-4925
Mailing Address - Fax:617-244-2507
Practice Address - Street 1:64 ELDREDGE ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-2017
Practice Address - Country:US
Practice Address - Phone:617-969-4925
Practice Address - Fax:617-244-2507
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1057041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPR P22145Medicare ID - Type UnspecifiedCLINICAL SOCIAL WORKER