Healthcare Provider Details

I. General information

NPI: 1013963099
Provider Name (Legal Business Name): LEONARD KLASKOW LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 10/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 66TH ST N
KENNETH CITY FL
33709-4918
US

IV. Provider business mailing address

9994 83RD ST
LARGO FL
33777-1910
US

V. Phone/Fax

Practice location:
  • Phone: 727-546-2405
  • Fax:
Mailing address:
  • Phone: 727-278-2949
  • Fax: 727-290-6075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW0002787
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW2787
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: