Basic Information
| Provider Information | |||||||||
| NPI: | 1144697467 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEO | ||||||||
| FirstName: | CLAUDIA | ||||||||
| MiddleName: | MARIA | ||||||||
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| Credential: | M.S.W., L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4918 LOCUST LN | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171094519 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4918 LOCUST LN | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171094519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176719610 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2015 | ||||||||
| LastUpdateDate: | 02/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | CW016119 | PA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 13608010 | 01 | PA | CAQH PROVIDER ID | OTHER |