Provider Demographics
NPI:1245658897
Name:LEO, GIA N (LCSW, LCADC)
Entity type:Individual
Prefix:MS
First Name:GIA
Middle Name:N
Last Name:LEO
Suffix:
Gender:
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 WILSON DR
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-3400
Mailing Address - Country:US
Mailing Address - Phone:862-268-3101
Mailing Address - Fax:
Practice Address - Street 1:50 WILSON DR
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-3400
Practice Address - Country:US
Practice Address - Phone:862-268-3101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-01
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00209600101YA0400X
NJ44SC055429001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical