Individual
MR. JOHN J LEAHY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
EDD
Contact information
Practice address
NOVA PSYCHIATRIC SERVICES INC, 1261 FURNACE BROOK PARKWAY, QUINCY, MA 02169
(617) 479-4545
(617) 479-4555
Mailing address
NOVA PSYCHIATRIC SERVICES INC, 1261 FURNACE BROOK PARKWAY, QUINCY, MA 02169
(617) 479-4545
(617) 479-4555
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
5084
MA
103TH0100X
Health Service Psychologist
5084
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1891227
—
MA
01
—
6100041
EVERCARE PROVIDER NUMBER
MA
01
—
W04815
BCBS PROVIDER NUMBER
MA
Enumeration date
10/16/2006
Last updated
02/26/2019
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