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General NPI Number Information
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NPI Number | 1104691625
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Entity Type | Individual
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Provider Name | MS. JENNA KAYLEENE LEESON
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Gender | Female
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Dates
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Enumeration Date | 11/15/2023
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Last Update Date | 11/15/2023
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Provider Practice Location Address
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Address Line | 50 W HAWTHORNE AVE
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City | VALLEY STREAM
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State | NY
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Zip | 11580-6223
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Country | US
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Telephone | 516-569-6600
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Fax |
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Provider Business Mailing Address
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Address Line | 776 6TH AVE APT 10E
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City | NEW YORK
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State | NY
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Zip | 10001-0165
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Country | US
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Telephone | 424-303-2590
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 120786
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License Number State | NY
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