Provider Demographics
NPI:1295553667
Name:MUSACCHIO, LEAH (LMSW)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:MUSACCHIO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3804 S COX AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-8603
Mailing Address - Country:US
Mailing Address - Phone:417-812-6850
Mailing Address - Fax:
Practice Address - Street 1:3804 S COX AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-8603
Practice Address - Country:US
Practice Address - Phone:417-812-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024033344104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker