Provider Demographics
NPI:1316490188
Name:LEICHTMAN, JEFFREY PETER (LCSW, LAC)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PETER
Last Name:LEICHTMAN
Suffix:
Gender:M
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9031 REX LN
Mailing Address - Street 2:
Mailing Address - City:CONIFER
Mailing Address - State:CO
Mailing Address - Zip Code:80433-9617
Mailing Address - Country:US
Mailing Address - Phone:617-230-0107
Mailing Address - Fax:
Practice Address - Street 1:9031 REX LN
Practice Address - Street 2:
Practice Address - City:CONIFER
Practice Address - State:CO
Practice Address - Zip Code:80433-9617
Practice Address - Country:US
Practice Address - Phone:617-230-0107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACD.0000536101YA0400X
COCSW.099235311041C0700X
CO1870711041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool