Provider Demographics
NPI:1619458304
Name:LEANN EGETO PHD LLC
Entity Type:Organization
Organization Name:LEANN EGETO PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SELF OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:EGETO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-651-0582
Mailing Address - Street 1:36 GLOUCESTER ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-2509
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:36 GLOUCESTER ST STE 300
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-2509
Practice Address - Country:US
Practice Address - Phone:617-651-0582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty