Provider Demographics
NPI:1467556639
Name:LEUTNER, THOMAS A (LCSW)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:LEUTNER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 BISHOP ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3717
Mailing Address - Country:US
Mailing Address - Phone:203-606-7676
Mailing Address - Fax:888-920-1026
Practice Address - Street 1:191 BISHOP ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3717
Practice Address - Country:US
Practice Address - Phone:203-606-7676
Practice Address - Fax:888-920-1026
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0044791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical