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General NPI Number Information
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NPI Number | 1275399131
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Entity Type | Individual
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Provider Name | MARK JOSEPH LEONIDA LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/27/2024
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 40 EXCHANGE PL STE 510
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City | NEW YORK
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State | NY
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Zip | 10005-2775
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Country | US
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Telephone | 212-523-4426
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Fax |
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Provider Business Mailing Address
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Address Line | 332 E ALLENS LN
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City | PHILADELPHIA
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State | PA
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Zip | 19119-1101
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Country | US
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Telephone | 551-998-6122
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 093883
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License Number State | NY
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