Provider Demographics
NPI:1124098439
Name:WEIL-LEFKOVITH, PATRICIA L (CCC-A)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:WEIL-LEFKOVITH
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 MILK ST
Mailing Address - Street 2:PROVIDER ENROLLMENT 9TH FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02109-4806
Mailing Address - Country:US
Mailing Address - Phone:617-559-8051
Mailing Address - Fax:
Practice Address - Street 1:43 IVY RD
Practice Address - Street 2:
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3620
Practice Address - Country:US
Practice Address - Phone:617-421-5984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB501027OtherCIGNA
MAPJ159OtherHARVARD PILGRIM
MA0014860OtherNEIGHBORHOOD HEALTH PLAN
MA5103061Medicaid
MAAD0165OtherBLUE CROSS
MA5103061Medicaid