Provider Demographics
NPI:1720751910
Name:MCLEOD, LUCILLE (LCSW)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:
Last Name:MCLEOD
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 1:1300 PARK WEST BLVD UNIT 108
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7029
Mailing Address - Country:US
Mailing Address - Phone:914-299-1935
Mailing Address - Fax:
Practice Address - Street 1:1300 PARK WEST BLVD UNIT 108
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29466-7029
Practice Address - Country:US
Practice Address - Phone:914-299-1935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-26
Last Update Date:2021-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0731551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY073155OtherPRIVATE