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General NPI Number Information
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NPI Number | 1962221325
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Entity Type | Individual
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Provider Name | LEODANIS UCETA JR.
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Gender | Male
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Dates
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Enumeration Date | 10/03/2024
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Last Update Date | 10/03/2024
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Provider Practice Location Address
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Address Line | 86 S HARRISON ST STE A
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City | EAST ORANGE
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State | NJ
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Zip | 07018-1748
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Country | US
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Telephone | 973-324-7879
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Fax |
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Provider Business Mailing Address
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Address Line | 8 STEVENS RD APT 73
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City | WALLINGTON
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State | NJ
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Zip | 07057-2757
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Country | US
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Telephone | 862-290-7383
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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