Provider Demographics
NPI:1295967545
Name:BIRD, LEE L (MSW)
Entity type:Individual
Prefix:MR
First Name:LEE
Middle Name:L
Last Name:BIRD
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 BELMONT ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-5299
Mailing Address - Country:US
Mailing Address - Phone:508-580-4691
Mailing Address - Fax:508-588-5751
Practice Address - Street 1:50 LONG POND DR
Practice Address - Street 2:
Practice Address - City:SOUTH YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02664-4180
Practice Address - Country:US
Practice Address - Phone:508-760-1475
Practice Address - Fax:508-398-4659
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical