Provider Demographics
NPI:1518247022
Name:EGETO, LEANN (LICSW, PHD)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:
Last Name:EGETO
Suffix:
Gender:F
Credentials:LICSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 GLOUCESTER ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-2509
Mailing Address - Country:US
Mailing Address - Phone:352-339-0134
Mailing Address - Fax:
Practice Address - Street 1:36 GLOUCESTER ST STE 300
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-2509
Practice Address - Country:US
Practice Address - Phone:352-339-0134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLLCSW 100391041C0700X
1041C0700X
MALICSW 1164971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical