Provider Demographics
NPI:1013989565
Name:LEFFERT, JAMES STEVEN (EDD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:STEVEN
Last Name:LEFFERT
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 GORHAM ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1934
Mailing Address - Country:US
Mailing Address - Phone:617-492-8393
Mailing Address - Fax:617-354-3684
Practice Address - Street 1:5 EDGELL RD
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4868
Practice Address - Country:US
Practice Address - Phone:508-370-9056
Practice Address - Fax:617-354-3684
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6678103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0525898Medicaid
MALEY62196Medicare ID - Type Unspecified