Provider Demographics
NPI:1275399131
Name:LEONIDA, MARK JOSEPH (LCSW)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:LEONIDA
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 E ALLENS LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-1101
Mailing Address - Country:US
Mailing Address - Phone:551-998-6122
Mailing Address - Fax:
Practice Address - Street 1:40 EXCHANGE PL STE 510
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10005-2775
Practice Address - Country:US
Practice Address - Phone:212-523-4426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0938831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical