Provider Demographics
NPI:1518441484
Name:DRISCOLL, LEAH KATHLEEN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LEAH
Middle Name:KATHLEEN
Last Name:DRISCOLL
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 1:144 KENRICK ST APT 17
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-3837
Mailing Address - Country:US
Mailing Address - Phone:617-407-2716
Mailing Address - Fax:
Practice Address - Street 1:1140 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3631
Practice Address - Country:US
Practice Address - Phone:617-747-3134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA120304-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical