Provider Demographics
NPI:1164785515
Name:LEUNISSEN-RIVERA, HEIDI (MS IN EDUCATION)
Entity Type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:
Last Name:LEUNISSEN-RIVERA
Suffix:
Gender:F
Credentials:MS IN EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:247 MILLER ROAD
Mailing Address - Street 2:
Mailing Address - City:CALLICOON
Mailing Address - State:NY
Mailing Address - Zip Code:12723
Mailing Address - Country:US
Mailing Address - Phone:845-482-3551
Mailing Address - Fax:
Practice Address - Street 1:247 MILLER ROAD
Practice Address - Street 2:
Practice Address - City:CALLICOON
Practice Address - State:NY
Practice Address - Zip Code:12723
Practice Address - Country:US
Practice Address - Phone:845-482-3551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator