Provider Demographics
NPI:1598891681
Name:HASAN, LEELA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LEELA
Middle Name:
Last Name:HASAN
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:PO BOX 6459
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46904-6459
Mailing Address - Country:US
Mailing Address - Phone:765-453-7422
Mailing Address - Fax:765-453-3773
Practice Address - Street 1:702 W ALTO ROAD
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902
Practice Address - Country:US
Practice Address - Phone:765-453-7422
Practice Address - Fax:765-453-3773
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002266A1041C0700X
IN35000151A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100154150AMedicaid
IN225230CMedicare ID - Type Unspecified
IND69625Medicare UPIN