MEDICARE: GEORGE ALFRED LEBOEUF III 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	225700000X	Massage Therapist	13946847-4701	UT
2	1041C0700X	Clinical Social Worker	13946847-3501	UT
3	1041C0700X	Clinical Social Worker	16063	CT
4	1041C0700X	Clinical Social Worker	SWB-2025-1293	NM

General Provider Information

NPI Number	:	1194560615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE ALFRED LEBOEUF III LCSW

Provider Business Mailing Address
First Line	:	57 W 9000 S # 104
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-2008
Country	:	US
Telephone Number	:	203-246-2733
Fax Number	:	844-835-0202

Provider Business Practice Location Address
First Line	:	57 W 9000 S STE 104
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-2008
Country	:	US
Telephone Number	:	385-722-4431
Fax Number	:

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

Provider Enumeration Date	:	06/26/2024
Last Update Date	:	01/20/2026

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