Provider Demographics
NPI:1548425564
Name:ASHMORE KEARSE, LEONA ANITA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LEONA
Middle Name:ANITA
Last Name:ASHMORE KEARSE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WYANDOTTE ST
Mailing Address - Street 2:
Mailing Address - City:SELDEN
Mailing Address - State:NY
Mailing Address - Zip Code:11784-4026
Mailing Address - Country:US
Mailing Address - Phone:516-238-1210
Mailing Address - Fax:631-451-0615
Practice Address - Street 1:57 WYANDOTTE ST
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-4026
Practice Address - Country:US
Practice Address - Phone:516-238-1210
Practice Address - Fax:631-451-0615
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014570-1103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent