Provider Demographics
NPI:1124743273
Name:LEON, MARCY (LCSW, CSW-PIP)
Entity type:Individual
Prefix:MRS
First Name:MARCY
Middle Name:
Last Name:LEON
Suffix:
Gender:F
Credentials:LCSW, CSW-PIP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 9 BOX 4491
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09123-0045
Mailing Address - Country:US
Mailing Address - Phone:305-452-8649
Mailing Address - Fax:
Practice Address - Street 1:NAURTATHER STRASSE 8B
Practice Address - Street 2:
Practice Address - City:ZEMMER
Practice Address - State:REINPLATZ
Practice Address - Zip Code:54313
Practice Address - Country:DE
Practice Address - Phone:305-452-8649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD48221041C0700X
FLSW143111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical