Provider Demographics
NPI:1962849265
Name:LEPORE, NOELLE GAYANE (LMFT)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:GAYANE
Last Name:LEPORE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:NOELLE
Other - Middle Name:GAYANE
Other - Last Name:ZEYTOONIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:81 PLANTATION ST
Mailing Address - Street 2:STE. 560
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01604-3069
Mailing Address - Country:US
Mailing Address - Phone:508-316-9567
Mailing Address - Fax:
Practice Address - Street 1:484 MAIN ST
Practice Address - Street 2:STE. 560
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1893
Practice Address - Country:US
Practice Address - Phone:508-316-9567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1522MF106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1522MFOtherBOARD OF ALLIED MENTAL HEALTH PROFESSIONAL LICENSURE