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General NPI Number Information
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NPI Number | 1124480645
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Entity Type | Individual
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Provider Name | ROBERT EUGENE LEEBURG LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 15315 MAGNOLIA BLVD STE 400
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1175
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Country | US
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Telephone | 818-860-1223
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Fax | 818-302-8182
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Provider Business Mailing Address
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Address Line | 5425 SANTA MONICA BLVD APT 409
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City | LOS ANGELES
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State | CA
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Zip | 90029-2326
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Country | US
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Telephone | 323-313-7558
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW104258
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License Number State | CA
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