Provider Demographics
NPI:1508266222
Name:LEET, ALEXANDRA (LCSW)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:LEET
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:502 FARRELL DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-3717
Mailing Address - Country:US
Mailing Address - Phone:859-578-3204
Mailing Address - Fax:859-578-3273
Practice Address - Street 1:7459 BURLINGTON PIKE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1553
Practice Address - Country:US
Practice Address - Phone:859-331-3292
Practice Address - Fax:859-578-2864
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY40611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY610661458OtherTAX ID