Provider Demographics
NPI:1003021437
Name:LEIGH, DIANA JO (LISW)
Entity Type:Individual
Prefix:MRS
First Name:DIANA
Middle Name:JO
Last Name:LEIGH
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3707 TOWNLEY RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5121
Mailing Address - Country:US
Mailing Address - Phone:216-283-1946
Mailing Address - Fax:216-283-1946
Practice Address - Street 1:24100 CHAGRIN BLVD
Practice Address - Street 2:SUITE 370
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5535
Practice Address - Country:US
Practice Address - Phone:216-292-6520
Practice Address - Fax:216-831-2351
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00038861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSW04522Medicare ID - Type Unspecified