Provider Demographics
NPI:1033746912
Name:LEAL, PHILIP MATTHEW (LCSW)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:MATTHEW
Last Name:LEAL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:PHIL
Other - Middle Name:
Other - Last Name:LEAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1430 COLLIER ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2911
Mailing Address - Country:US
Mailing Address - Phone:512-703-1394
Mailing Address - Fax:
Practice Address - Street 1:1213 SABINE ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1917
Practice Address - Country:US
Practice Address - Phone:512-804-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX606461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical