Provider Demographics
NPI:1639159627
Name:GLASS, LEONARD LIEBES (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:LIEBES
Last Name:GLASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:72 WILLISTON RD
Mailing Address - Street 2:
Mailing Address - City:AUBURNDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02466-2270
Mailing Address - Country:US
Mailing Address - Phone:617-965-1928
Mailing Address - Fax:617-965-1928
Practice Address - Street 1:115 MILL STREET
Practice Address - Street 2:MCLEAN HOSPITAL
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-9106
Practice Address - Country:US
Practice Address - Phone:617-965-1928
Practice Address - Fax:617-965-1928
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA320462084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry