Provider Demographics
NPI:1104089978
Name:MEEHAN, LEILA (MA, CAGS, BCBA)
Entity type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:MEEHAN
Suffix:
Gender:F
Credentials:MA, CAGS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 LANGLEY RD
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-5700
Mailing Address - Country:US
Mailing Address - Phone:781-619-1500
Mailing Address - Fax:617-388-7594
Practice Address - Street 1:65 LANGLEY RD
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-5700
Practice Address - Country:US
Practice Address - Phone:617-388-7594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2018-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-07-3305103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst