Healthcare Provider Details

I. General information

NPI: 1760470694
Provider Name (Legal Business Name): LEIGH A BARNES MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9111 BROADWAY BRAODFIELD CENTER, SUITE N
MERRILLVILLE IN
46410-8122
US

IV. Provider business mailing address

9111 BROADWAY BRAODFIELD CENTER, SUITE N
MERRILLVILLE IN
46410-8122
US

V. Phone/Fax

Practice location:
  • Phone: 219-707-5518
  • Fax:
Mailing address:
  • Phone: 219-707-5518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2150611
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005249A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: