Provider Demographics
NPI:1497928170
Name:LEADHOLM, EMILY FRANCES (LICSW)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:FRANCES
Last Name:LEADHOLM
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 1:30 EASTMAN RD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-1306
Mailing Address - Country:US
Mailing Address - Phone:617-625-9349
Mailing Address - Fax:
Practice Address - Street 1:71 WALKER ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-2414
Practice Address - Country:US
Practice Address - Phone:617-913-8659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1116101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical