Healthcare Provider Details

I. General information

NPI: 1063348357
Provider Name (Legal Business Name): TIARA AUBREE LEON MHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2545 SEDGWICK AVE APT 1C
BRONX NY
10468-3802
US

IV. Provider business mailing address

275 NORTH ST
HARRISON NY
10528-1140
US

V. Phone/Fax

Practice location:
  • Phone: 718-926-9975
  • Fax:
Mailing address:
  • Phone: 914-967-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP141398
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: