Healthcare Provider Details

I. General information

NPI: 1619256526
Provider Name (Legal Business Name): CAROL A LEUNG PHD, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3506 10TH AVE
LOS ANGELES CA
90018-3331
US

IV. Provider business mailing address

3506 10TH AVE
LOS ANGELES CA
90018-3331
US

V. Phone/Fax

Practice location:
  • Phone: 512-593-2045
  • Fax:
Mailing address:
  • Phone: 281-797-7860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number084269
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number80567
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: