Provider Demographics
NPI:1366590911
Name:COPASS, LEAH JANE (MED, LMHC)
Entity type:Individual
Prefix:MS
First Name:LEAH
Middle Name:JANE
Last Name:COPASS
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 LINDEN PL
Mailing Address - Street 2:#1
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7811
Mailing Address - Country:US
Mailing Address - Phone:617-264-9212
Mailing Address - Fax:617-264-9213
Practice Address - Street 1:29 LINDEN PL
Practice Address - Street 2:#1
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7811
Practice Address - Country:US
Practice Address - Phone:617-264-9212
Practice Address - Fax:617-264-9213
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1871101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional