Provider Demographics
NPI:1962776153
Name:LEAVENS, LINDA L (RN, LCSW, CASAC)
Entity type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:L
Last Name:LEAVENS
Suffix:
Gender:F
Credentials:RN, LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 LORD HOWE ST.
Mailing Address - Street 2:
Mailing Address - City:TICONDEROGA
Mailing Address - State:NY
Mailing Address - Zip Code:12883
Mailing Address - Country:US
Mailing Address - Phone:518-586-6568
Mailing Address - Fax:518-585-3265
Practice Address - Street 1:166 LORD HOWE ST.
Practice Address - Street 2:
Practice Address - City:TICONDEROGA
Practice Address - State:NY
Practice Address - Zip Code:12883
Practice Address - Country:US
Practice Address - Phone:518-586-6568
Practice Address - Fax:518-585-3265
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-06
Last Update Date:2012-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16940101YA0400X
NY068145-1104100000X
NY362081-1163W00000X
NY080134-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No163W00000XNursing Service ProvidersRegistered Nurse