Provider Demographics
NPI:1366985681
Name:TEGLOVIC, LEAH (LCSW)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:TEGLOVIC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-1091 LAAULU ST APT F
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-4448
Mailing Address - Country:US
Mailing Address - Phone:808-209-2151
Mailing Address - Fax:
Practice Address - Street 1:91-1091 LAAULU ST APT F
Practice Address - Street 2:
Practice Address - City:EWA BEACH
Practice Address - State:HI
Practice Address - Zip Code:96706-4448
Practice Address - Country:US
Practice Address - Phone:808-209-2151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI41671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical