Provider Demographics
NPI:1275388456
Name:EDWARDS, LEANNA (BSW, MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:
Last Name:EDWARDS
Suffix:
Gender:F
Credentials:BSW, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 WATERMARKE PL
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-7686
Mailing Address - Country:US
Mailing Address - Phone:702-626-0665
Mailing Address - Fax:
Practice Address - Street 1:2204 WATERMARKE PL
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-7686
Practice Address - Country:US
Practice Address - Phone:702-626-0665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-20
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1011471041C0700X
NV11410-C1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical