Healthcare Provider Details

I. General information

NPI: 1295890572
Provider Name (Legal Business Name): ELIZABETH RUSS LEINWEBER LCSW BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 N SWAN RD SUITE 234
TUCSON AZ
85712
US

IV. Provider business mailing address

PO BOX 64002
TUCSON AZ
85728
US

V. Phone/Fax

Practice location:
  • Phone: 520-327-5522
  • Fax: 520-327-5525
Mailing address:
  • Phone: 520-327-5522
  • Fax: 520-327-5525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW2595
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW1974
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: