Provider Demographics
NPI:1104979988
Name:LEAVY, JANE H (MSW)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:H
Last Name:LEAVY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 FLORAL ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON HIGHLANDS
Mailing Address - State:MA
Mailing Address - Zip Code:02461-1245
Mailing Address - Country:US
Mailing Address - Phone:617-964-6061
Mailing Address - Fax:617-964-1317
Practice Address - Street 1:6 FLORAL ST
Practice Address - Street 2:
Practice Address - City:NEWTON HIGHLANDS
Practice Address - State:MA
Practice Address - Zip Code:02461-1245
Practice Address - Country:US
Practice Address - Phone:617-964-6061
Practice Address - Fax:617-964-1317
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO2058OtherBLUE CROSS BLUE SHIELD PR
MALE-P23791Medicare ID - Type Unspecified