Provider Demographics
NPI:1770590986
Name:LEONARD, ERIN K (PHD, MSW, LCSW)
Entity type:Individual
Prefix:DR
First Name:ERIN
Middle Name:K
Last Name:LEONARD
Suffix:
Gender:F
Credentials:PHD, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3835 EDISON LAKES PARKWAY
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-3414
Mailing Address - Country:US
Mailing Address - Phone:574-210-0303
Mailing Address - Fax:574-247-1662
Practice Address - Street 1:3835 EDISON LAKES PARKWAY
Practice Address - Street 2:SUITE # 200
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3414
Practice Address - Country:US
Practice Address - Phone:574-210-0303
Practice Address - Fax:574-247-1662
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005199A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000486409OtherANTHEM PIN NUMBER
IN252560DMedicare PIN