MEDICARE: MRS. LEAH WITHINGTON TRAVERS-PUCCI 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	149.009267	IL
2	1041C0700X	Clinical Social Worker	LW61401524	WA

General Provider Information

NPI Number	:	1326557471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LEAH WITHINGTON TRAVERS-PUCCI LCSW

Provider Business Mailing Address
First Line	:	1813 N MILL ST STE B
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-4872
Country	:	US
Telephone Number	:	630-428-2344
Fax Number	:

Provider Business Practice Location Address
First Line	:	1813 N MILL ST STE B
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-4872
Country	:	US
Telephone Number	:	630-428-2344
Fax Number	:

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

Provider Enumeration Date	:	09/20/2017
Last Update Date	:	06/17/2025

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