Provider Demographics
NPI:1679194146
Name:MARASA, LEAH REECE
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:REECE
Last Name:MARASA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:REECE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:30 MILL LN
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-1547
Mailing Address - Country:US
Mailing Address - Phone:857-264-0054
Mailing Address - Fax:
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2025-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MA11723103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program