Individual
LEON O. BACK IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
78 BAKER ST, PROVIDENCE, RI 02905-4417
(401) 781-2400
(401) 781-2687
Mailing address
78 BAKER ST, PROVIDENCE, RI 02905-4417
(401) 781-2400
(401) 781-2687
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
ISW03876
RI
Other
Enumeration date
12/03/2018
Last updated
04/04/2024
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