Provider Demographics
NPI:1174876304
Name:LEON, GABRIEL LEE (LCSW)
Entity type:Individual
Prefix:MR
First Name:GABRIEL
Middle Name:LEE
Last Name:LEON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5105 PEACOCK LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3101
Mailing Address - Country:US
Mailing Address - Phone:805-907-8779
Mailing Address - Fax:909-259-2897
Practice Address - Street 1:5TH STREET & WESTERN
Practice Address - Street 2:
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-0991
Practice Address - Country:US
Practice Address - Phone:951-737-2683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-25
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60774104100000X
CA791871041S0200X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool