Provider Demographics
NPI:1336238286
Name:BARTH, LEISA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LEISA
Middle Name:
Last Name:BARTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 WESTRIDGE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-1148
Mailing Address - Country:US
Mailing Address - Phone:814-444-9696
Mailing Address - Fax:814-444-9696
Practice Address - Street 1:445 WESTRIDGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-1148
Practice Address - Country:US
Practice Address - Phone:814-444-9696
Practice Address - Fax:814-444-9696
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW125000104100000X
PACW0161411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker