Provider Demographics
NPI:1639417702
Name:LEONARD, CHRISTIE (LCSW)
Entity Type:Individual
Prefix:
First Name:CHRISTIE
Middle Name:
Last Name:LEONARD
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 1:1120 E KENNEDY BLVD
Mailing Address - Street 2:UNIT 1124
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3580
Mailing Address - Country:US
Mailing Address - Phone:781-264-7022
Mailing Address - Fax:
Practice Address - Street 1:3010 W AZEELE ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3139
Practice Address - Country:US
Practice Address - Phone:781-264-7022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2184821041C0700X
FLSW 126091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical