MEDICARE: LEISA ROBINSON SOCIAL WORKER

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	104100000X	Social Worker	CP00138885	WV
2	1041C0700X	Clinical Social Worker	DP00138885	WV

General Provider Information

NPI Number	:	1760927271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEISA ROBINSON SOCIAL WORKER

Provider Business Mailing Address
First Line	:	497 MALL RD
Second Line	:
City	:	OAK HILL
State	:	WV
Zip	:	25901-6216
Country	:	US
Telephone Number	:	304-469-2905
Fax Number	:	304-465-1518

Provider Business Practice Location Address
First Line	:	850 INDEPENDENCE RD.
Second Line	:
City	:	COAL CITY
State	:	WV
Zip	:	25823
Country	:	US
Telephone Number	:	304-469-2905
Fax Number	:	304-469-2981

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

Provider Enumeration Date	:	12/20/2016
Last Update Date	:	10/11/2023

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