Provider Demographics
NPI:1174922470
Name:LEADER, LARISA JOYCE MCEACHRAN (LCSW)
Entity type:Individual
Prefix:
First Name:LARISA
Middle Name:JOYCE MCEACHRAN
Last Name:LEADER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 PINE DR
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60051-2600
Mailing Address - Country:US
Mailing Address - Phone:734-740-8877
Mailing Address - Fax:
Practice Address - Street 1:1907 PINE DR
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60051-2600
Practice Address - Country:US
Practice Address - Phone:734-740-8877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0169611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical