Provider Demographics
NPI:1205918000
Name:LEITNER, CHARLES RAYMOND (LCSW)
Entity type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:RAYMOND
Last Name:LEITNER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1249 LANDSBROOK DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-3576
Mailing Address - Country:US
Mailing Address - Phone:317-722-0368
Mailing Address - Fax:
Practice Address - Street 1:3833 N MERIDIAN ST
Practice Address - Street 2:SUITE 120
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46208-4039
Practice Address - Country:US
Practice Address - Phone:317-927-6440
Practice Address - Fax:317-927-6447
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL23271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical