Provider Demographics
NPI:1295249878
Name:GIA LEO, LCSW, LCADC, LLC
Entity type:Organization
Organization Name:GIA LEO, LCSW, LCADC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LCADC
Authorized Official - Phone:862-268-3101
Mailing Address - Street 1:25 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1937
Mailing Address - Country:US
Mailing Address - Phone:862-268-3101
Mailing Address - Fax:
Practice Address - Street 1:25 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1937
Practice Address - Country:US
Practice Address - Phone:862-268-3101
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-19
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055429001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty