Provider Demographics
NPI:1316545510
Name:DAGESSE, LEONARD PAUL
Entity Type:Individual
Prefix:MR
First Name:LEONARD
Middle Name:PAUL
Last Name:DAGESSE
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:LENNY
Other - Middle Name:
Other - Last Name:DAGESSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:51 GLADSTONE ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-3338
Mailing Address - Country:US
Mailing Address - Phone:704-517-4701
Mailing Address - Fax:
Practice Address - Street 1:51 GLADSTONE ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-3338
Practice Address - Country:US
Practice Address - Phone:704-517-4701
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health