Provider Demographics
NPI:1780716910
Name:LUNA, LEONARD (MSW, MSG)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:LUNA
Suffix:
Gender:M
Credentials:MSW, MSG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-4545
Mailing Address - Country:US
Mailing Address - Phone:323-730-1312
Mailing Address - Fax:
Practice Address - Street 1:1541 3RD AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-4545
Practice Address - Country:US
Practice Address - Phone:323-730-1312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW17358101YM0800X
CAASW73971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health