Provider Demographics
NPI:1477186682
Name:PROSPER, GINAI LESLIE (LMHC)
Entity Type:Individual
Prefix:
First Name:GINAI
Middle Name:LESLIE
Last Name:PROSPER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 LANDFORD DR
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-4111
Mailing Address - Country:US
Mailing Address - Phone:516-668-3825
Mailing Address - Fax:
Practice Address - Street 1:123 GROVE AVE STE 216
Practice Address - Street 2:
Practice Address - City:CEDARHURST
Practice Address - State:NY
Practice Address - Zip Code:11516-2302
Practice Address - Country:US
Practice Address - Phone:516-350-8564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-16
Last Update Date:2022-01-04
Deactivation Date:2021-07-22
Deactivation Code:
Reactivation Date:2022-01-04
Provider Licenses
StateLicense IDTaxonomies
NY009882101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health