Healthcare Provider Details

I. General information

NPI: 1053611442
Provider Name (Legal Business Name): LEONARD JAMES REOME LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 MINOMA AVE
LOUISVILLE KY
40217-2436
US

IV. Provider business mailing address

847 MINOMA AVE
LOUISVILLE KY
40217-2436
US

V. Phone/Fax

Practice location:
  • Phone: 502-262-1075
  • Fax:
Mailing address:
  • Phone: 502-262-1075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3710
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: