Provider Demographics
NPI:1972654234
Name:ABBOTT, LEAL M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LEAL
Middle Name:M
Last Name:ABBOTT
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 1:827 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3537
Mailing Address - Country:US
Mailing Address - Phone:530-668-1363
Mailing Address - Fax:530-668-8160
Practice Address - Street 1:827 NORTH ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3537
Practice Address - Country:US
Practice Address - Phone:530-668-1363
Practice Address - Fax:530-668-8160
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS9307101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health