Provider Demographics
NPI:1760683668
Name:LEOPOLD, SAUL MARTIN (MSW, PHD)
Entity Type:Individual
Prefix:DR
First Name:SAUL
Middle Name:MARTIN
Last Name:LEOPOLD
Suffix:
Gender:M
Credentials:MSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 200
Mailing Address - Street 2:
Mailing Address - City:THE SEA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:95497-0200
Mailing Address - Country:US
Mailing Address - Phone:707-523-8390
Mailing Address - Fax:707-785-3982
Practice Address - Street 1:1275 4TH ST
Practice Address - Street 2:623
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4057
Practice Address - Country:US
Practice Address - Phone:707-523-8390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 4131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical