Provider Demographics
NPI:1548325178
Name:LEAVITT, NAOMI (PHD)
Entity type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:
Last Name:LEAVITT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 620154
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02462-0154
Mailing Address - Country:US
Mailing Address - Phone:781-673-2647
Mailing Address - Fax:
Practice Address - Street 1:CAMBRIDGE COURT CLINIC
Practice Address - Street 2:40 THORNDIKE ST.
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141
Practice Address - Country:US
Practice Address - Phone:617-577-7243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4457103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic