Provider Demographics
NPI:1083963441
Name:LEBER, RENEE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:LEBER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:BERLIN HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44814-0145
Mailing Address - Country:US
Mailing Address - Phone:419-515-6865
Mailing Address - Fax:
Practice Address - Street 1:66 CENTER ST
Practice Address - Street 2:
Practice Address - City:BERLIN HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44814-9603
Practice Address - Country:US
Practice Address - Phone:419-515-6865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-31
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.12000371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846675Medicaid