Healthcare Provider Details

I. General information

NPI: 1407590573
Provider Name (Legal Business Name): LEANNE CHRISTINE ZINN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 LAKE AVE STE 1
SAINT JAMES NY
11780-2979
US

IV. Provider business mailing address

339 PHILADELPHIA AVE
MASSAPEQUA PK NY
11762-1818
US

V. Phone/Fax

Practice location:
  • Phone: 631-312-7123
  • Fax:
Mailing address:
  • Phone: 516-282-5910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number001936
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: