Healthcare Provider Details

I. General information

NPI: 1245658897
Provider Name (Legal Business Name): GIA N LEO LCSW, LCADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 WILSON DR
SPARTA NJ
07871-3400
US

IV. Provider business mailing address

50 WILSON DR
SPARTA NJ
07871-3400
US

V. Phone/Fax

Practice location:
  • Phone: 862-268-3101
  • Fax:
Mailing address:
  • Phone: 862-268-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05542900
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number37LC00209600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: