Provider Demographics
NPI:1134261928
Name:LEEMASTER, LAURA DENISE (LCSW, ACSW)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:DENISE
Last Name:LEEMASTER
Suffix:
Gender:F
Credentials:LCSW, ACSW
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:D
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:815 MAIN ST.
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:ST. JOSEPH
Mailing Address - State:MI
Mailing Address - Zip Code:49085
Mailing Address - Country:US
Mailing Address - Phone:269-982-4055
Mailing Address - Fax:219-462-9000
Practice Address - Street 1:4004 CAMPBELL
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385
Practice Address - Country:US
Practice Address - Phone:219-462-9000
Practice Address - Fax:219-462-9000
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003981A1041C0700X
MI68010900521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000219941OtherBLUE CROSSBLUE SHIELD
11490947OtherCAQH LAURA SMITH/LEEMASTER