Provider Demographics
NPI:1417574443
Name:DONALDSON-NEVAREZ, LEATHER (LCSW)
Entity Type:Individual
Prefix:
First Name:LEATHER
Middle Name:
Last Name:DONALDSON-NEVAREZ
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 1:2160 W GRANT LINE RD STE 215
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377-7333
Mailing Address - Country:US
Mailing Address - Phone:209-640-4179
Mailing Address - Fax:209-207-9225
Practice Address - Street 1:2160 W GRANT LINE RD STE 215
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377-7333
Practice Address - Country:US
Practice Address - Phone:209-640-4179
Practice Address - Fax:209-207-9225
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA939491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical