Healthcare Provider Details

I. General information

NPI: 1508338500
Provider Name (Legal Business Name): JOHN LECKIE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 BOSTON POST RD
WEST HAVEN CT
06516-2043
US

IV. Provider business mailing address

6 SHAWS CV
NEW LONDON CT
06320-4969
US

V. Phone/Fax

Practice location:
  • Phone: 203-932-5711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4584
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: