Basic Information
| Provider Information | |||||||||
| NPI: | 1871750265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEONARD | ||||||||
| FirstName: | J | ||||||||
| MiddleName: | KEVIN | ||||||||
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| Credential: | CASAC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6100 | ||||||||
| Address2: | BLDG #16 N COUNTY COMPLEX SUFFOLK CNTY DEPT OF HEALTH | ||||||||
| City: | HAUPPAUGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318536281 | ||||||||
| FaxNumber: | 6318536254 | ||||||||
| Practice Location | |||||||||
| Address1: | BLDG #16 N COUNTY COMPLEX | ||||||||
| Address2: | SUFFOLK CNTY DEPT OF HEALTH DAY REPORTING CENTER | ||||||||
| City: | HAUPPAUGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318536281 | ||||||||
| FaxNumber: | 6318536254 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2008 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 7169 | NY | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.