MEDICARE: KATHERINE MAVIS LEAHEY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904012546	VA

General Provider Information

NPI Number	:	1164091575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE MAVIS LEAHEY LCSW

Provider Business Mailing Address
First Line	:	12300 WASHINGTON HWY
Second Line	:
City	:	ASHLAND
State	:	VA
Zip	:	23005-7646
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8475 BELL CREEK RD
Second Line	:
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-3866
Country	:	US
Telephone Number	:	804-365-6760
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2021
Last Update Date	:	06/21/2021

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