Healthcare Provider Details

I. General information

NPI: 1073719001
Provider Name (Legal Business Name): PATTI LEAHY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 02/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8555 TAFT ST.
MERRILLVILLE IN
46410-6123
US

IV. Provider business mailing address

8400 LOUISIANA ST.
MERRILLVILLE IN
46410-6385
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-4005
  • Fax: 219-769-2508
Mailing address:
  • Phone: 219-757-1928
  • Fax: 219-757-1980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number149003721
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number149003721
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005948A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: