Provider Demographics
NPI:1609402593
Name:GOLD, LEAH (LMSW)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N BROOM ST FL 2
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53703-5207
Mailing Address - Country:US
Mailing Address - Phone:608-319-4390
Mailing Address - Fax:608-729-3434
Practice Address - Street 1:301 N BROOM ST FL 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-5207
Practice Address - Country:US
Practice Address - Phone:608-319-4390
Practice Address - Fax:608-729-3434
Is Sole Proprietor?:No
Enumeration Date:2020-03-23
Last Update Date:2023-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9482-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical