Provider Demographics
NPI:1730178856
Name:LEBLANG, KAREN M (LCSW)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:M
Last Name:LEBLANG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8141 E FLORENTINE RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-9427
Mailing Address - Country:US
Mailing Address - Phone:928-759-8998
Mailing Address - Fax:928-759-9209
Practice Address - Street 1:8141 E FLORENTINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:PRESCOTT VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86314-9427
Practice Address - Country:US
Practice Address - Phone:928-759-8998
Practice Address - Fax:928-759-9209
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW107091104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ75843Medicare ID - Type Unspecified