Provider Demographics
NPI:1962524256
Name:CARMODY, LEIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:LEIE
Middle Name:
Last Name:CARMODY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 WEAVER ST
Mailing Address - Street 2:
Mailing Address - City:WEST WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02576-1356
Mailing Address - Country:US
Mailing Address - Phone:508-295-0164
Mailing Address - Fax:508-295-0164
Practice Address - Street 1:50 JAMAICAWAY
Practice Address - Street 2:#2
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-1009
Practice Address - Country:US
Practice Address - Phone:617-734-9933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALCSW 200231.21041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPS 0213OtherBCBS
P20416Medicare ID - Type Unspecified