Healthcare Provider Details

I. General information

NPI: 1235299173
Provider Name (Legal Business Name): LESLEA TOWNSEND CRONIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 GRANT LINE RD
NEW ALBANY IN
47150-2137
US

IV. Provider business mailing address

4007 GRANT LINE RD
NEW ALBANY IN
47150-2137
US

V. Phone/Fax

Practice location:
  • Phone: 502-523-6122
  • Fax:
Mailing address:
  • Phone: 502-523-6122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34005578A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberKY-3181
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: