Provider Demographics
NPI:1013204411
Name:LEBRUN, JOHN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:LEBRUN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1W MAIN ST 203
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2620
Mailing Address - Country:US
Mailing Address - Phone:631-656-8555
Mailing Address - Fax:631-656-8553
Practice Address - Street 1:1W MAIN ST 203
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2620
Practice Address - Country:US
Practice Address - Phone:631-656-8555
Practice Address - Fax:631-656-8553
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-06
Last Update Date:2015-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0792641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical