Provider Demographics
NPI:1407382161
Name:MCCOLLUM, LEAH J (LCSW)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:J
Last Name:MCCOLLUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 374
Mailing Address - Street 2:
Mailing Address - City:CANTERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06331-0374
Mailing Address - Country:US
Mailing Address - Phone:817-658-4002
Mailing Address - Fax:
Practice Address - Street 1:100 PEARL ST FL 14
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06103-4500
Practice Address - Country:US
Practice Address - Phone:817-658-4002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-02
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT117861041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical