Provider Demographics
NPI:1225259245
Name:MAGRE, LEANN L (MSSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LEANN
Middle Name:L
Last Name:MAGRE
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7407 ERIC EDWARD WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-5703
Mailing Address - Country:US
Mailing Address - Phone:502-290-6864
Mailing Address - Fax:
Practice Address - Street 1:7407 ERIC EDWARD WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-5703
Practice Address - Country:US
Practice Address - Phone:502-290-6864
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY13441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical