Healthcare Provider Details

I. General information

NPI: 1245809284
Provider Name (Legal Business Name): ADAM LEBRON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81 RIDGEWOOD AVE
BROOKLYN NY
11208-1023
US

IV. Provider business mailing address

81 RIDGEWOOD AVE
BROOKLYN NY
11208-1023
US

V. Phone/Fax

Practice location:
  • Phone: 347-898-9736
  • Fax:
Mailing address:
  • Phone: 347-898-9736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: