Provider Demographics
NPI:1215522164
Name:LEEBRON, CHAUSEY (LMFT MA)
Entity type:Individual
Prefix:
First Name:CHAUSEY
Middle Name:
Last Name:LEEBRON
Suffix:
Gender:F
Credentials:LMFT MA
Other - Prefix:
Other - First Name:CHAUSEY
Other - Middle Name:
Other - Last Name:LEEBRON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT MA
Mailing Address - Street 1:215 MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-1529
Mailing Address - Country:US
Mailing Address - Phone:512-573-8409
Mailing Address - Fax:
Practice Address - Street 1:215 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-1529
Practice Address - Country:US
Practice Address - Phone:512-573-8409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT27.002021106H00000X
TX201007106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist