MEDICARE: LESHIA D DERRINGER 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	252535	KY

General Provider Information

NPI Number	:	1568930436
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESHIA D DERRINGER LCSW

Provider Business Mailing Address
First Line	:	8206 HIGHVIEW CT
Second Line	:
City	:	CRESTWOOD
State	:	KY
Zip	:	40014-8105
Country	:	US
Telephone Number	:	502-262-2887
Fax Number	:	502-426-2045

Provider Business Practice Location Address
First Line	:	1608 HILL RISE DR
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-2503
Country	:	US
Telephone Number	:	866-623-8249
Fax Number	:

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

Provider Enumeration Date	:	11/08/2018
Last Update Date	:	11/08/2018

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