Healthcare Provider Details

I. General information

NPI: 1922218569
Provider Name (Legal Business Name): LEONIE S PRINCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 E SALEM ST
HACKENSACK NJ
07601-7427
US

IV. Provider business mailing address

816 PALMER AVE
MAYWOOD NJ
07607-1628
US

V. Phone/Fax

Practice location:
  • Phone: 201-646-0333
  • Fax:
Mailing address:
  • Phone: 732-547-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number253270
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number25MA08955500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: