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General NPI Number Information
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NPI Number | 1164968582
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Entity Type | Organization
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Legal Business Name | CHRISTOPHER J. LEONARD, MSW, LCSW, M.ED.
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Dates
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Enumeration Date | 01/09/2017
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 118 PROSPECT ST SUITE 5
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-4473
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Country | US
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Telephone | 201-447-3621
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Fax | 201-291-2190
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Provider Business Mailing Address
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Address Line | 118 PROSPECT ST SUITE 5
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-4473
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Country | US
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Telephone | 201-447-3621
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Fax | 201-291-2190
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Authorized Official
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Title or Position | OWNER
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Name | CHRISTOPHER J LEONARD
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Credential | MSW, LCSW, M.ED.
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Telephone | 201-447-3621
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 44SC044556400
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License Number State | NJ
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