Provider Demographics
NPI:1124480645
Name:LEEBURG, ROBERT EUGENE (LCSW)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EUGENE
Last Name:LEEBURG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5425 SANTA MONICA BLVD APT 409
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029-2326
Mailing Address - Country:US
Mailing Address - Phone:323-313-7558
Mailing Address - Fax:
Practice Address - Street 1:15315 MAGNOLIA BLVD STE 400
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1175
Practice Address - Country:US
Practice Address - Phone:818-860-1223
Practice Address - Fax:818-302-8182
Is Sole Proprietor?:No
Enumeration Date:2016-03-23
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1042581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical