Provider Demographics
NPI:1649936360
Name:STOCK-LEACH, BRIANNA MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:MARIE
Last Name:STOCK-LEACH
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 1:718 KELLYS CV
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-2255
Mailing Address - Country:US
Mailing Address - Phone:407-574-0492
Mailing Address - Fax:
Practice Address - Street 1:718 KELLYS CV
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2255
Practice Address - Country:US
Practice Address - Phone:407-574-0492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL191521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical