MEDICARE: DEBRA K LEEDS LCSW

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	C005097	NC

General Provider Information

NPI Number	:	1861450207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBRA K LEEDS LCSW

Provider Business Mailing Address
First Line	:	154 MINE LAKE CT STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-6417
Country	:	US
Telephone Number	:	919-389-9952
Fax Number	:

Provider Business Practice Location Address
First Line	:	154 MINE LAKE CT STE 200
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27615-6417
Country	:	US
Telephone Number	:	919-389-9952
Fax Number	:

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	01/29/2019

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