Provider Demographics
NPI:1902940935
Name:LETITIA, TODD DENNIS (LMHC)
Entity Type:Individual
Prefix:MR
First Name:TODD
Middle Name:DENNIS
Last Name:LETITIA
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 HENRY ST
Mailing Address - Street 2:
Mailing Address - City:WEST BOYLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:01583-1607
Mailing Address - Country:US
Mailing Address - Phone:508-835-2941
Mailing Address - Fax:
Practice Address - Street 1:14 HENRY ST
Practice Address - Street 2:
Practice Address - City:WEST BOYLSTON
Practice Address - State:MA
Practice Address - Zip Code:01583-1607
Practice Address - Country:US
Practice Address - Phone:508-835-2941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5062101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health