=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104679844
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEIGH JEREMY BRITTON LMSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2024
-----------------------------------------------------
Last Update Date | 04/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1270 6TH AVE FL 8
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10020-1702
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 212-710-2629
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 227 W 131ST ST APT 7
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10027-2091
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 901-289-9029
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 121215-01
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------