Provider Demographics
NPI:1962978957
Name:COBURN, LEAH CHRISTINE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:CHRISTINE
Last Name:COBURN
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:CHRISTINE
Other - Last Name:PETRACCA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-732-5500
Mailing Address - Fax:
Practice Address - Street 1:1070 IYANNOUGH RD
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1871
Practice Address - Country:US
Practice Address - Phone:508-948-3400
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1216491041C0700X
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical