Provider Demographics
NPI:1225382799
Name:LEON, ALBERTO LUIS (BA)
Entity Type:Individual
Prefix:
First Name:ALBERTO
Middle Name:LUIS
Last Name:LEON
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 WASHINGTON ST
Mailing Address - Street 2:2
Mailing Address - City:ROSLINDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02131-1203
Mailing Address - Country:US
Mailing Address - Phone:617-983-5827
Mailing Address - Fax:617-983-5854
Practice Address - Street 1:3815 WASHINGTON ST
Practice Address - Street 2:2
Practice Address - City:ROSLINDALE
Practice Address - State:MA
Practice Address - Zip Code:02131-1203
Practice Address - Country:US
Practice Address - Phone:617-983-5827
Practice Address - Fax:617-983-5854
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health