Provider Demographics
NPI:1952884835
Name:LEAHY, FREEA (LICSW)
Entity Type:Individual
Prefix:
First Name:FREEA
Middle Name:
Last Name:LEAHY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:MA
Mailing Address - Zip Code:02563-2819
Mailing Address - Country:US
Mailing Address - Phone:617-429-8673
Mailing Address - Fax:
Practice Address - Street 1:52 MACKINLAY WAY
Practice Address - Street 2:
Practice Address - City:ROCKLAND
Practice Address - State:MA
Practice Address - Zip Code:02370-2373
Practice Address - Country:US
Practice Address - Phone:781-871-8406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1117341041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool