Provider Demographics
NPI:1114790565
Name:HAGOPIAN, LEILA (LMSW)
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:
Last Name:HAGOPIAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 BLAUVELT DR
Mailing Address - Street 2:
Mailing Address - City:HARRINGTON PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07640-1330
Mailing Address - Country:US
Mailing Address - Phone:201-543-4661
Mailing Address - Fax:
Practice Address - Street 1:250 1ST AVE APT 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-2612
Practice Address - Country:US
Practice Address - Phone:201-543-4661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121797-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker