Provider Demographics
NPI:1235545062
Name:LEONARDI-GREENE, CARRIE (MS)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:LEONARDI-GREENE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 ROBERT AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3336
Mailing Address - Country:US
Mailing Address - Phone:516-457-1515
Mailing Address - Fax:
Practice Address - Street 1:457 ROBERT AVE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3336
Practice Address - Country:US
Practice Address - Phone:516-457-1515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor