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General NPI Number Information
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NPI Number | 1689182610
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Entity Type | Organization
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Legal Business Name | DEAN LEONE DBA CORE RECOVERY, LLC
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Dates
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Enumeration Date | 01/11/2018
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 5 DURHAM RD
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City | GUILFORD
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State | CT
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Zip | 06437-2076
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Country | US
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Telephone | 203-314-6794
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Fax |
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Provider Business Mailing Address
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Address Line | 41 CRESCENT BLUFF AVE
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City | BRANFORD
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State | CT
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Zip | 06405-5503
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Country | US
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Telephone | 203-314-6794
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DEAN R LEONE
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Credential | PSYCHOLOGIST, PHD
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Telephone | 203-314-6794
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2089
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License Number State | CT
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