Provider Demographics
NPI:1598192700
Name:LEICHOMBAM, SIKENDRO
Entity Type:Individual
Prefix:
First Name:SIKENDRO
Middle Name:
Last Name:LEICHOMBAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 ALDEN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-2614
Mailing Address - Country:US
Mailing Address - Phone:617-803-3859
Mailing Address - Fax:
Practice Address - Street 1:596 ALDEN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-2614
Practice Address - Country:US
Practice Address - Phone:617-803-3859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker