Provider Demographics
NPI:1891085320
Name:LEBER, CARRIE JEAN (APSW)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:JEAN
Last Name:LEBER
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 60TH ST
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-4041
Mailing Address - Country:US
Mailing Address - Phone:262-654-5333
Mailing Address - Fax:262-654-7818
Practice Address - Street 1:920 60TH ST
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-4041
Practice Address - Country:US
Practice Address - Phone:262-654-5333
Practice Address - Fax:262-654-7818
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-18
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1281891211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical