Provider Demographics
NPI:1639472764
Name:GREENSPOON, KATIE LEIGH (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATIE
Middle Name:LEIGH
Last Name:GREENSPOON
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 1:10933 BAL HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-4546
Mailing Address - Country:US
Mailing Address - Phone:561-809-5107
Mailing Address - Fax:
Practice Address - Street 1:10933 BAL HARBOR DR
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33498-4546
Practice Address - Country:US
Practice Address - Phone:561-809-5107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-12
Last Update Date:2010-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL97481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical