MEDICARE: MS. LEONIE LUXAMA LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	084649	NY

General Provider Information

NPI Number	:	1205195468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LEONIE LUXAMA LCSW

Provider Business Mailing Address
First Line	:	1261 OCEAN AVE
Second Line	:	APT D
City	:	BROOKLYN
State	:	NY
Zip	:	11230
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1921 AVENUE K APT A5
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4941
Country	:	US
Telephone Number	:	347-668-4989
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	09/20/2017

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