Provider Demographics
NPI:1295180610
Name:VINCENZO, LEANN (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:LEANN
Middle Name:
Last Name:VINCENZO
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126B ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-1530
Mailing Address - Country:US
Mailing Address - Phone:740-310-3464
Mailing Address - Fax:
Practice Address - Street 1:229 W MARIETTA ST
Practice Address - Street 2:
Practice Address - City:WOODSFIELD
Practice Address - State:OH
Practice Address - Zip Code:43793-1051
Practice Address - Country:US
Practice Address - Phone:740-472-9022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-04
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS 1502559104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker