MEDICARE: MS. LEAH LEATHERBEE LCSW-R

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	R070588-1	NY

General Provider Information

NPI Number	:	1861889529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEAH LEATHERBEE LCSW-R

Provider Business Mailing Address
First Line	:	245 WEST 29TH STREET, SUITE 304
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-5208
Country	:	US
Telephone Number	:	718-930-7126
Fax Number	:	646-726-4072

Provider Business Practice Location Address
First Line	:	245 WEST 29TH STREET, SUITE 304
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10001-5208
Country	:	US
Telephone Number	:	718-930-7126
Fax Number	:	646-726-4072

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

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	04/21/2015

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