Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Leon O. Back IV, LICSW

Individual provider Clinical Social Worker · NPI 1720558745

Leon O. Back IV, LICSW is a Clinical Social Worker in Providence, Rhode Island. Qualified in 2020, 6 years ago. Practices with Coastal Medical Physicians Inc, a 219-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Rhode Island.

Years since qualifying
6
Licensed in
RI
In the registry since
2018
What do these letters mean?
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

78 Baker St
Providence, RI 02905-4417
Phone: (401) 781-2400
Fax: (401) 781-2687
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence ISW03876 (RI)

Record details

NPI number1720558745
Entity typeIndividual (Type 1)
GenderMale
Credentials LICSW
Sole proprietorNo
NPI enumeratedDecember 3, 2018
Last updated in NPPESApril 4, 2024
Certification dateApril 4, 2024
Mailing address78 Baker St, Providence, RI 02905-4417

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Group practice Coastal Medical Physicians Inc — 219 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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