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General NPI Number Information
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NPI Number | 1881627388
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Entity Type | Organization
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Legal Business Name | ERNEST LEUCI LCSW PC
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Dates
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Enumeration Date | 07/08/2006
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Last Update Date | 03/31/2022
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Provider Practice Location Address
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Address Line | 3 PREMIER CT
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-3198
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Country | US
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Telephone | 631-476-7119
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Fax | 631-476-7119
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Provider Business Mailing Address
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Address Line | 3 PREMIER CT
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City | PORT JEFFERSON STATION
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State | NY
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Zip | 11776-3198
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Country | US
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Telephone | 631-476-7119
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Fax | 631-476-7119
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Authorized Official
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Title or Position | PRESIDENT CLINICAL SOCIAL WORKER
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Name | MR. ERNEST LEUCI
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Credential | LCSWR
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Telephone | 631-476-7119
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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 | R053666-1
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License Number State | NY
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