Provider Demographics
NPI:1932991783
Name:LEDDIE, COLLEEN VERONICA
Entity type:Individual
Prefix:MRS
First Name:COLLEEN
Middle Name:VERONICA
Last Name:LEDDIE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:COLLEEN
Other - Middle Name:VERONICA
Other - Last Name:LEDDIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1200 WASHINGTON ST APT 120
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2132
Mailing Address - Country:US
Mailing Address - Phone:307-203-7923
Mailing Address - Fax:
Practice Address - Street 1:3368 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02130-5519
Practice Address - Country:US
Practice Address - Phone:307-203-7923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW2289111041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker