Provider Demographics
NPI:1851023808
Name:LEEBY, DENISE R (LCSW)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:R
Last Name:LEEBY
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 1:1329 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58102-2720
Mailing Address - Country:US
Mailing Address - Phone:701-367-0057
Mailing Address - Fax:
Practice Address - Street 1:3369 39TH ST S STE 3
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7542
Practice Address - Country:US
Practice Address - Phone:701-367-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND34511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical