Provider Demographics
NPI:1154482792
Name:LEONARDO, DEBRA (LCSW-R)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:LEONARDO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:BLERSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:180 BROADWAY
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4256
Mailing Address - Country:US
Mailing Address - Phone:516-935-6858
Mailing Address - Fax:516-935-7179
Practice Address - Street 1:180 BROADWAY
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:HICKSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11801-4256
Practice Address - Country:US
Practice Address - Phone:516-935-6858
Practice Address - Fax:516-935-7179
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074119-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical