Provider Demographics
NPI:1679613681
Name:LEBBAD, IRENE COLUCCI (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:COLUCCI
Last Name:LEBBAD
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 ALEXANDRIA WAY
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-2763
Mailing Address - Country:US
Mailing Address - Phone:908-625-2237
Mailing Address - Fax:
Practice Address - Street 1:71 4TH ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-3235
Practice Address - Country:US
Practice Address - Phone:908-963-7645
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053647001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical