Provider Demographics
NPI:1578621181
Name:SARROUF, LEZA MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:LEZA
Middle Name:MARIE
Last Name:SARROUF
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 1:36 SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1801
Mailing Address - Country:US
Mailing Address - Phone:617-923-9984
Mailing Address - Fax:
Practice Address - Street 1:75 FOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-6210
Practice Address - Country:US
Practice Address - Phone:508-879-9800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10319791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical