Provider Demographics
NPI:1598911489
Name:MADORSKY, LEILAH R (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LEILAH
Middle Name:R
Last Name:MADORSKY
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 1:180 NEWPORT CENTER DR STE 158
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0934
Mailing Address - Country:US
Mailing Address - Phone:949-719-1800
Mailing Address - Fax:
Practice Address - Street 1:1001 DOVE ST # 791-7138
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2838
Practice Address - Country:US
Practice Address - Phone:949-791-7138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-12
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW664381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical