Provider Demographics
NPI:1336987296
Name:TIRILOK, LEANNE
Entity type:Individual
Prefix:
First Name:LEANNE
Middle Name:
Last Name:TIRILOK
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 1:86 WASHINGTON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-3673
Mailing Address - Country:US
Mailing Address - Phone:978-460-4687
Mailing Address - Fax:
Practice Address - Street 1:1R NEWBURY ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-4065
Practice Address - Country:US
Practice Address - Phone:617-804-2773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-16
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health