Provider Demographics
NPI:1720045370
Name:JOECKEL, LEANNE (LICSW)
Entity Type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:JOECKEL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:
Other - Last Name:THURBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:82 W MAIN ST
Mailing Address - Street 2:STE. 5C
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-1879
Mailing Address - Country:US
Mailing Address - Phone:508-614-9049
Mailing Address - Fax:800-395-9156
Practice Address - Street 1:82 W MAIN ST
Practice Address - Street 2:STE. 5C
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1879
Practice Address - Country:US
Practice Address - Phone:508-614-9049
Practice Address - Fax:800-395-9156
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-27
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1111271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23022Medicare ID - Type Unspecified