Provider Demographics
NPI:1760730873
Name:ROBERTSON, LEIGH SHANNON (LCSW)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:SHANNON
Last Name:ROBERTSON
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 1:3403 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4349
Mailing Address - Country:US
Mailing Address - Phone:502-553-2158
Mailing Address - Fax:502-415-7257
Practice Address - Street 1:3403 WINCHESTER RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4349
Practice Address - Country:US
Practice Address - Phone:502-553-2158
Practice Address - Fax:502-415-7257
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-21
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical