Provider Demographics
NPI:1811477904
Name:LEACH, DANIELLE M (MS, MSW, LSW)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:M
Last Name:LEACH
Suffix:
Gender:F
Credentials:MS, MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20231 PAINT BLVD
Mailing Address - Street 2:
Mailing Address - City:SHIPPENVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:16254-4625
Mailing Address - Country:US
Mailing Address - Phone:814-226-1159
Mailing Address - Fax:814-227-2876
Practice Address - Street 1:20231 PAINT BLVD
Practice Address - Street 2:
Practice Address - City:SHIPPENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16254-4625
Practice Address - Country:US
Practice Address - Phone:814-229-0446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW135229104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker