Provider Demographics
NPI:1578580155
Name:ZOLA, LEONORA K (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEONORA
Middle Name:K
Last Name:ZOLA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 MOON HILL RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6113
Mailing Address - Country:US
Mailing Address - Phone:781-862-8495
Mailing Address - Fax:
Practice Address - Street 1:4 MOON HILL RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-6113
Practice Address - Country:US
Practice Address - Phone:781-862-8495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA411103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0505102Medicaid
AMYSIS # 44650OtherMAGELLAN
ZO WO 1376OtherBLUE CROSS/BLUE SHIELD
ZO WO 1376OtherBLUE CROSS/BLUE SHIELD