Provider Demographics
NPI:1528170131
Name:MCNABB, LEONARD M (MSW)
Entity type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:M
Last Name:MCNABB
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:TUNKHANNOCK
Mailing Address - State:PA
Mailing Address - Zip Code:18657-1303
Mailing Address - Country:US
Mailing Address - Phone:570-836-3118
Mailing Address - Fax:
Practice Address - Street 1:99 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:TUNKHANNOCK
Practice Address - State:PA
Practice Address - Zip Code:18657-1303
Practice Address - Country:US
Practice Address - Phone:570-836-3118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-000431-L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
R-07832Medicare UPIN
64045Medicare ID - Type Unspecified