Provider Demographics
NPI:1558842740
Name:BEIDLER, LEAH (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:BEIDLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MRS
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:BEIDLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:159 CONCORD AVE APT 1C
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-2333
Mailing Address - Country:US
Mailing Address - Phone:802-295-7397
Mailing Address - Fax:
Practice Address - Street 1:29 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-2116
Practice Address - Country:US
Practice Address - Phone:978-740-1193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-24
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA120908101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool