Provider Demographics
NPI:1477846426
Name:LOGAN, LEAH DARE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:DARE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 WASHINGTON ST
Mailing Address - Street 2:STE 4
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-2347
Mailing Address - Country:US
Mailing Address - Phone:508-813-3593
Mailing Address - Fax:774-469-3180
Practice Address - Street 1:480 WASHINGTON ST
Practice Address - Street 2:STE 4
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-2347
Practice Address - Country:US
Practice Address - Phone:508-813-3593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8941103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical