MEDICARE: LEANNE PETERSON 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	58.008846	CT
2	1041C0700X	Clinical Social Worker	61226	TX

General Provider Information

NPI Number	:	1750682969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEANNE PETERSON LCSW

Provider Business Mailing Address
First Line	:	945 MCKINNEY ST # 21010
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77002-6308
Country	:	US
Telephone Number	:	713-352-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4119 MONTROSE BLVD STE 450
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-4966
Country	:	US
Telephone Number	:	713-352-0600
Fax Number	:

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

Provider Enumeration Date	:	11/04/2010
Last Update Date	:	02/21/2022

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