Provider Demographics
NPI:1851486997
Name:LEAF, MARILYN GROSSMAN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:GROSSMAN
Last Name:LEAF
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 1:4732 DEL MORENO DR
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-4626
Mailing Address - Country:US
Mailing Address - Phone:818-884-9833
Mailing Address - Fax:818-703-0992
Practice Address - Street 1:4732 DEL MORENO DR
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-4626
Practice Address - Country:US
Practice Address - Phone:818-884-9833
Practice Address - Fax:818-703-0992
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS41681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical