Provider Demographics
NPI:1114353240
Name:LEE-SYDNOR, LEANNA R (LCSW, CASAC-2)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:R
Last Name:LEE-SYDNOR
Suffix:
Gender:F
Credentials:LCSW, CASAC-2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RIVERDALE AVE APT 12K
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-4618
Mailing Address - Country:US
Mailing Address - Phone:914-361-5993
Mailing Address - Fax:
Practice Address - Street 1:107 S BROADWAY
Practice Address - Street 2:
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-4006
Practice Address - Country:US
Practice Address - Phone:914-378-7102
Practice Address - Fax:914-378-7273
Is Sole Proprietor?:No
Enumeration Date:2013-09-20
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0933831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWVE061OtherMEDICARE#
NY02449154Medicaid
NYWVE061OtherMEDICARE#