=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538200670
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIE NADINE LEONTY LCSW- R
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/10/2007
-----------------------------------------------------
Last Update Date | 11/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 64 JEFFERSON STREET SUITE 1
-----------------------------------------------------
City | MONTICELLO
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12701-2325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-797-8800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3191 ROUTE 94
-----------------------------------------------------
City | CHESTER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10918-2325
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-642-1892
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 63119
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number | 203394615
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------