Provider Demographics
NPI:1619338530
Name:FUGATE, LEONARD ALBERT (MSW/LSW)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:ALBERT
Last Name:FUGATE
Suffix:
Gender:M
Credentials:MSW/LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:930 PRAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:45177-7590
Mailing Address - Country:US
Mailing Address - Phone:513-751-7747
Mailing Address - Fax:
Practice Address - Street 1:930 PRAIRIE RD
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177-7590
Practice Address - Country:US
Practice Address - Phone:513-751-7747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-20
Last Update Date:2016-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1451422104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker