Individual
MRS. JUDITH LEICHTBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
1301 FARMINGTON AVE, FARMINGTON, CT 06032
(860) 677-2550
(860) 677-4975
Mailing address
1301 FARMINGTON AVE, FARMINGTON, CT 06032
(860) 677-2550
(860) 677-4975
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
003489
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140003489CT04
ANTHEM BC
CT
01
—
211793
MANAGED HEALTH NET
CT
Enumeration date
03/21/2006
Last updated
12/17/2007
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