Provider Demographics
NPI:1255514097
Name:GAGE, LEAH J (SSP, CEIS)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:J
Last Name:GAGE
Suffix:
Gender:F
Credentials:SSP, CEIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3922
Mailing Address - Country:US
Mailing Address - Phone:508-775-6240
Mailing Address - Fax:
Practice Address - Street 1:83 PEARL ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3922
Practice Address - Country:US
Practice Address - Phone:508-775-6240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-16
Last Update Date:2007-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator