Provider Demographics
NPI:1588759658
Name:MAC LEOD, LAURIE A (MED LMHC)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:A
Last Name:MAC LEOD
Suffix:
Gender:F
Credentials:MED LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 FRONT ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MARION
Mailing Address - State:MA
Mailing Address - Zip Code:02738
Mailing Address - Country:US
Mailing Address - Phone:508-748-0606
Mailing Address - Fax:508-748-0665
Practice Address - Street 1:345 FRONT ST
Practice Address - Street 2:SUITE 203
Practice Address - City:MARION
Practice Address - State:MA
Practice Address - Zip Code:02738
Practice Address - Country:US
Practice Address - Phone:508-748-0606
Practice Address - Fax:508-748-0665
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHH 19801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2049807OtherCIGNA
MA6241353OtherUBH
MA322965OtherMBH
MALM0251OtherBCBS