Basic Information
| Provider Information | |||||||||
| NPI: | 1891015129 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TENNEN | ||||||||
| FirstName: | LEAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
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| Credential: | MPH, CHES, LICSW | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | HART | ||||||||
| OtherFirstName: | LEAH | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 250 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | NORTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027662436 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 425 CENTRE ST | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024582063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172441990 | ||||||||
| FaxNumber: | 6172441811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2010 | ||||||||
| LastUpdateDate: | 06/09/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 113898 | MA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.