Provider Demographics
NPI:1457540726
Name:LEROY, DEBRA JANE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:JANE
Last Name:LEROY
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:PO BOX 340
Mailing Address - Street 2:
Mailing Address - City:ROLLING PRAIRIE
Mailing Address - State:IN
Mailing Address - Zip Code:46371
Mailing Address - Country:US
Mailing Address - Phone:219-324-3325
Mailing Address - Fax:219-324-3324
Practice Address - Street 1:1730 E LINCOLNWAY
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350
Practice Address - Country:US
Practice Address - Phone:219-324-3325
Practice Address - Fax:219-324-3324
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34003713A1041C0700X
IN34003713A/87001021A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical