MEDICARE: PAGE LEIGH PEARSON LCSW, CTMH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C7850	MS

General Provider Information

NPI Number	:	1275047383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAGE LEIGH PEARSON LCSW, CTMH

Provider Business Mailing Address
First Line	:	1907 PASS RD STE G
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39531-4101
Country	:	US
Telephone Number	:	228-819-8818
Fax Number	:

Provider Business Practice Location Address
First Line	:	1907 PASS RD STE G
Second Line	:
City	:	BILOXI
State	:	MS
Zip	:	39531-4101
Country	:	US
Telephone Number	:	228-819-8818
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2017
Last Update Date	:	05/17/2021

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