Healthcare Provider Details

I. General information

NPI: 1124192117
Provider Name (Legal Business Name): LEONARD F SZYMCZAK MSW LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23705 MARINER DR # 183
MONARCH BEACH CA
92629-4306
US

IV. Provider business mailing address

23705 MARINER DR # 183
MONARCH BEACH CA
92629-4306
US

V. Phone/Fax

Practice location:
  • Phone: 949-443-4888
  • Fax:
Mailing address:
  • Phone: 949-443-4888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149003726
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 23713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: