MEDICARE: STEVEN MICHAEL LEEDS M.S.W.

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1760546279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN MICHAEL LEEDS M.S.W.

Provider Business Mailing Address
First Line	:	2261 ELM ST
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94559-3721
Country	:	US
Telephone Number	:	707-253-4785
Fax Number	:

Provider Business Practice Location Address
First Line	:	2344 OLD SONOMA RD
Second Line	:
City	:	NAPA
State	:	CA
Zip	:	94559-3708
Country	:	US
Telephone Number	:	707-253-4785
Fax Number	:

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

Provider Enumeration Date	:	12/20/2006
Last Update Date	:	07/08/2007

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