Healthcare Provider Details

I. General information

NPI: 1417267261
Provider Name (Legal Business Name): GREGORY E. LEONARD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2010
Last Update Date: 10/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 DUTCH HOLLOW RD. BEMUS POINT CENTRAL SCHOOL DISTRICT
BEMUS POINT NY
14712-3980
US

IV. Provider business mailing address

PO BOX 468 BEMUS POINT CENTRAL SCHOOL DISTRICT
BEMUS POINT NY
14712-0468
US

V. Phone/Fax

Practice location:
  • Phone: 716-386-4932
  • Fax: 716-386-2376
Mailing address:
  • Phone: 716-386-4932
  • Fax: 716-386-2376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number010489
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: