Provider Demographics
NPI:1093225542
Name:LEACY, ADRIEN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:ADRIEN
Middle Name:
Last Name:LEACY
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:ADRIENNE
Other - Middle Name:
Other - Last Name:KURKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1504 MCCULLOH ST FL 1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-3439
Mailing Address - Country:US
Mailing Address - Phone:312-351-3537
Mailing Address - Fax:
Practice Address - Street 1:10 W EAGER ST STE 324
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-5743
Practice Address - Country:US
Practice Address - Phone:443-420-8037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-10
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD206461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical