Provider Demographics
NPI:1386375236
Name:DELONG, LEAH
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:DELONG
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 1:55 COTTAGE FARM RD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4053
Mailing Address - Country:US
Mailing Address - Phone:617-817-1266
Mailing Address - Fax:
Practice Address - Street 1:55 COTTAGE FARM RD UNIT 2
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4053
Practice Address - Country:US
Practice Address - Phone:617-817-1266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-22
Last Update Date:2022-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician