Provider Demographics
NPI:1417575721
Name:ABBY LEEFER, LICENSED CLINICAL SOCIAL WORKER, PC
Entity Type:Organization
Organization Name:ABBY LEEFER, LICENSED CLINICAL SOCIAL WORKER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:LABRIOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:631-553-6360
Mailing Address - Street 1:35 PURITAN PATH
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-1456
Mailing Address - Country:US
Mailing Address - Phone:631-928-9808
Mailing Address - Fax:
Practice Address - Street 1:710 MAIN ST
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2278
Practice Address - Country:US
Practice Address - Phone:631-928-9808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty