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NPI Code Detail

MEDICARE: MR. BRYAN MICHAEL LEACH LMSW

MEDICARE: MR. BRYAN MICHAEL LEACH LMSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker098803NY

General Provider Information

NPI Number : 1427665710
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. BRYAN MICHAEL LEACH LMSW
Provider Business Mailing Address
First Line : 150 W 28TH ST STE 1901
Second Line :
City : NEW YORK
State : NY
Zip : 10001-6179
Country : US
Telephone Number : 646-543-0203
Fax Number :
Provider Business Practice Location Address
First Line : 150 W 28TH ST STE 1901
Second Line :
City : NEW YORK
State : NY
Zip : 10001-6179
Country : US
Telephone Number : 646-543-0203
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2020
Last Update Date : 11/15/2024

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