Provider Demographics
NPI:1154758522
Name:LEIGH, VIRGINIA
Entity type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:LEIGH
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 1:20 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01901-1201
Mailing Address - Country:US
Mailing Address - Phone:781-477-7222
Mailing Address - Fax:781-598-8137
Practice Address - Street 1:20 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01901-1201
Practice Address - Country:US
Practice Address - Phone:781-477-7222
Practice Address - Fax:781-598-8137
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1187361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical