Provider Demographics
NPI:1083845168
Name:MCKIVER, LEON (CASAC)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:MCKIVER
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-5704
Mailing Address - Country:US
Mailing Address - Phone:845-343-7675
Mailing Address - Fax:845-343-2501
Practice Address - Street 1:21 CENTER ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-5704
Practice Address - Country:US
Practice Address - Phone:845-343-7675
Practice Address - Fax:845-343-2501
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2009-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8580101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)