Provider Demographics
NPI:1568180271
Name:LEIS, JANINE
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:
Last Name:LEIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 TANNER RD
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-2124
Mailing Address - Country:US
Mailing Address - Phone:774-571-2841
Mailing Address - Fax:
Practice Address - Street 1:21 TANNER RD
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-2124
Practice Address - Country:US
Practice Address - Phone:774-571-2841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker