Provider Demographics
NPI:1154487064
Name:LEEDS, MARCIA E (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:E
Last Name:LEEDS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HALSTEAD AVE SUITE 103
Mailing Address - Street 2:
Mailing Address - City:MAMAMORECK
Mailing Address - State:NY
Mailing Address - Zip Code:10543-2743
Mailing Address - Country:US
Mailing Address - Phone:914-771-6661
Mailing Address - Fax:914-771-6661
Practice Address - Street 1:650 HALSTEAD AVE SUITE 103
Practice Address - Street 2:
Practice Address - City:MAMAMORECK
Practice Address - State:NY
Practice Address - Zip Code:10543-2743
Practice Address - Country:US
Practice Address - Phone:914-771-6661
Practice Address - Fax:914-771-6661
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR03688011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01875341Medicaid
NYN42541Medicare ID - Type Unspecified