Provider Demographics
NPI:1649573288
Name:MACLEOD, BRITTANY A (LCSW)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:A
Last Name:MACLEOD
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 1:6101 BALL RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3963
Mailing Address - Country:US
Mailing Address - Phone:307-254-3299
Mailing Address - Fax:
Practice Address - Street 1:6101 BALL RD STE 304
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-3966
Practice Address - Country:US
Practice Address - Phone:307-254-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-20
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLCSW-7621041C0700X
CA725111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1649573288OtherGROUP