Vicki M Leopold, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW003385 Issued in GA

Practice address

170 Broadmoor Dr
Fayetteville, GA 30215-2714

Phone

(770) 461-0284

Fax

(770) 461-0284

NPI assigned

Sep 20, 2005

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Vicki M Strom Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689660235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "170 BROADMOOR DR",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302152714",
            "telephone_number": "770-461-0284",
            "fax_number": "770-461-0284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "170 BROADMOOR DR",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302152714",
            "telephone_number": "770-461-0284",
            "fax_number": "770-461-0284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEOPOLD",
        "first_name": "VICKI",
        "middle_name": "M",
        "name_prefix": "Mrs.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW003385",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "654749047A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VICKI",
            "last_name": "STROM",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Foster Kennard Lester, PTA
• Asia M Lewis

• Clinical Social Worker in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.