Provider Demographics
NPI:1316474844
Name:LEONARD, CHRISTOPHER (MSW, LICSW, LCSW)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:LEONARD
Suffix:
Gender:M
Credentials:MSW, LICSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MAIN ST UNIT 208
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05753-7408
Mailing Address - Country:US
Mailing Address - Phone:201-723-6995
Mailing Address - Fax:
Practice Address - Street 1:6 MILL ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:VT
Practice Address - Zip Code:05753-1132
Practice Address - Country:US
Practice Address - Phone:201-723-6995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-15
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0964141041C0700X
NJ44SCO45565001041C0700X
VT089.01343641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY096414OtherLICENSED CLINICAL SOCIAL WORKER
VT089.0134364OtherLICENSED INDEPENDENT CLINICAL SOCIAL WORKER
1164968582OtherNPI
NJ44SCO4556500OtherLICENSED CLINICAL SOCIAL WORKER