Healthcare Provider Details

I. General information

NPI: 1922184662
Provider Name (Legal Business Name): LEAH TOPEK-WALKER LCSW-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 11/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 N OCEAN AVE
PATCHOGUE NY
11772-2004
US

IV. Provider business mailing address

168 N OCEAN AVE
PATCHOGUE NY
11772-2004
US

V. Phone/Fax

Practice location:
  • Phone: 516-524-4554
  • Fax: 631-588-8901
Mailing address:
  • Phone: 516-524-4554
  • Fax: 631-588-8901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number077631-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier03346765
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: