Provider Demographics
NPI:1295347920
Name:ROSE, LEAH K
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:K
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 WALBRIDGE ST APT 2
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-3806
Mailing Address - Country:US
Mailing Address - Phone:615-507-8494
Mailing Address - Fax:
Practice Address - Street 1:54 WASHBURN AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-1128
Practice Address - Country:US
Practice Address - Phone:617-864-0941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health