Healthcare Provider Details

I. General information

NPI: 1043497746
Provider Name (Legal Business Name): LAURA ANN LEONE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E 168TH ST
BRONX NY
10452-7929
US

IV. Provider business mailing address

279 MAIN ST SUITE 204
NEW PALTZ NY
12561-1623
US

V. Phone/Fax

Practice location:
  • Phone: 718-293-3900
  • Fax: 718-293-3980
Mailing address:
  • Phone: 845-255-3046
  • Fax: 845-255-0236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number076509
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: