Provider Demographics
NPI:1730742982
Name:LIGHT, LEAH GLUKLICK (LMSW)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:GLUKLICK
Last Name:LIGHT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:GLIKLICK
Other - Last Name:BRAUN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:25180 LAHSER RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-5866
Mailing Address - Country:US
Mailing Address - Phone:248-262-2205
Mailing Address - Fax:
Practice Address - Street 1:25180 LAHSER RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-5866
Practice Address - Country:US
Practice Address - Phone:248-262-2205
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-15
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010993751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical