Provider Demographics
NPI:1588805147
Name:LEDDY, JENNIFER ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:LEDDY
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 1:317 MATTHEWS MINT HILL RD
Mailing Address - Street 2:113
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-2795
Mailing Address - Country:US
Mailing Address - Phone:704-776-6573
Mailing Address - Fax:980-245-8864
Practice Address - Street 1:317 MATTHEWS MINT HILL RD
Practice Address - Street 2:113
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2795
Practice Address - Country:US
Practice Address - Phone:704-776-6573
Practice Address - Fax:980-245-8864
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-11
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0045681041C0700X
NY0568311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical