Provider Demographics
NPI:1639644651
Name:SARKISSIAN, LEO V (MSW)
Entity Type:Individual
Prefix:MR
First Name:LEO
Middle Name:V
Last Name:SARKISSIAN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PINTAIL RD
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-4357
Mailing Address - Country:US
Mailing Address - Phone:617-838-8832
Mailing Address - Fax:
Practice Address - Street 1:THE ARC OF MASSACHUSETTS
Practice Address - Street 2:217 SOUTH STREET
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453
Practice Address - Country:US
Practice Address - Phone:781-891-6270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-05
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104968-SW-LICSW104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker