Provider Demographics
NPI:1578058186
Name:DEBENEDICTIS, LEONARD THOMAS (MSW)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:THOMAS
Last Name:DEBENEDICTIS
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 BERRYWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GROVELAND
Mailing Address - State:MA
Mailing Address - Zip Code:01834-1057
Mailing Address - Country:US
Mailing Address - Phone:508-320-6546
Mailing Address - Fax:
Practice Address - Street 1:5 BERRYWOOD LN
Practice Address - Street 2:
Practice Address - City:GROVELAND
Practice Address - State:MA
Practice Address - Zip Code:01834-1057
Practice Address - Country:US
Practice Address - Phone:508-320-6546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1047741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical