Provider Demographics
NPI:1407996747
Name:LEITMAN, JILL AARONS (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JILL
Middle Name:AARONS
Last Name:LEITMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4549 CHAMBLEE DUNWOODY RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30338-6210
Mailing Address - Country:US
Mailing Address - Phone:678-948-4015
Mailing Address - Fax:770-677-9400
Practice Address - Street 1:3159 ROYAL DR
Practice Address - Street 2:SUITE #330
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022-2461
Practice Address - Country:US
Practice Address - Phone:678-948-4015
Practice Address - Fax:678-948-4030
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0034431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA80BBFZWMedicare ID - Type Unspecified
GAQ44608Medicare UPIN