Provider Demographics
NPI:1629260666
Name:LEON, MAGDALENA MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MAGDALENA
Middle Name:MARIE
Last Name:LEON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MAGGIE
Other - Middle Name:MARIE
Other - Last Name:LEON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2016 AURORA DRIVE
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013
Mailing Address - Country:US
Mailing Address - Phone:405-623-7156
Mailing Address - Fax:
Practice Address - Street 1:921 NE 13TH
Practice Address - Street 2:VAMC-OKC SOCIAL WORK
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-456-3652
Practice Address - Fax:405-456-1538
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK33261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical