Provider Demographics
NPI:1376136713
Name:LEONETTI, STEPHANIE JOANNE (LLMSW)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:JOANNE
Last Name:LEONETTI
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 PACKARD ST STE 280
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-2276
Mailing Address - Country:US
Mailing Address - Phone:734-224-2454
Mailing Address - Fax:
Practice Address - Street 1:3830 PACKARD ST STE 280
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-2276
Practice Address - Country:US
Practice Address - Phone:734-224-2454
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011088671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical