Provider Demographics
NPI:1831213313
Name:LEO, SARA ACKER (PSYD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:ACKER
Last Name:LEO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:MAYS
Other - Last Name:ACKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:264 BEACON STREET
Mailing Address - Street 2:FLOOR 5
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116
Mailing Address - Country:US
Mailing Address - Phone:617-444-9055
Mailing Address - Fax:
Practice Address - Street 1:264 BEACON STREET
Practice Address - Street 2:FLOOR 5
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116
Practice Address - Country:US
Practice Address - Phone:617-444-9055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X, 103TH0004X
MA9040103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth