Healthcare Provider Details

I. General information

NPI: 1801179593
Provider Name (Legal Business Name): LEIGH A REPOSA LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85A BEACH ST
WESTERLY RI
02891-2717
US

IV. Provider business mailing address

75 PEQUOT TRL
PAWCATUCK CT
06379-1435
US

V. Phone/Fax

Practice location:
  • Phone: 401-952-7260
  • Fax:
Mailing address:
  • Phone: 401-952-7260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISWO2665
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: