Provider Demographics
NPI:1093360539
Name:LEOGRANDE, JACQUELYN K (LMSW)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:K
Last Name:LEOGRANDE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:K
Other - Last Name:HARFORD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:1011 1ST AVE FL 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4112
Mailing Address - Country:US
Mailing Address - Phone:212-371-1000
Mailing Address - Fax:212-371-1512
Practice Address - Street 1:1990 WESTCHESTER AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10462-4553
Practice Address - Country:US
Practice Address - Phone:718-792-9937
Practice Address - Fax:718-792-9803
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-01
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073085-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker