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General NPI Number Information
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NPI Number | 1467812628
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Entity Type | Organization
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Legal Business Name | LEONIS MARIE PERONE
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Dates
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Enumeration Date | 03/01/2016
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Last Update Date | 03/01/2016
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Provider Practice Location Address
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Address Line | 1717 SWEDE RD STE 110
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City | BLUE BELL
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State | PA
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Zip | 19422-3372
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Country | US
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Telephone | 610-639-1158
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Fax | 610-879-2282
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Provider Business Mailing Address
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Address Line | 614 BUTTONWOOD ST
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City | NORRISTOWN
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State | PA
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Zip | 19401-4231
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Country | US
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Telephone | 610-639-1158
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Fax |
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Authorized Official
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Title or Position | OWNER,THERAPIST
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Name | LEONIS MARIE PERONE
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Credential | LCSW
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Telephone | 610-639-1158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | CW012715
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License Number State | PA
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