Provider Demographics
NPI:1023540317
Name:LEACE, LISA RENEE (LISW-S, LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:LEACE
Suffix:
Gender:F
Credentials:LISW-S, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11651 NORBOURNE DR
Mailing Address - Street 2:APARTMENT 1708
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45240-2100
Mailing Address - Country:US
Mailing Address - Phone:513-378-5665
Mailing Address - Fax:
Practice Address - Street 1:11651 NORBOURNE DR
Practice Address - Street 2:APARTMENT 1708
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45240-2100
Practice Address - Country:US
Practice Address - Phone:513-378-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.10001621041C0700X
IN34007063A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical