Provider Demographics
NPI:1548617244
Name:VERMAAT, LESLIE (LMHC)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:VERMAAT
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 1:311 GARFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-5457
Mailing Address - Country:US
Mailing Address - Phone:607-239-5766
Mailing Address - Fax:607-239-5857
Practice Address - Street 1:311 GARFIELD AVE
Practice Address - Street 2:
Practice Address - City:ENDICOTT
Practice Address - State:NY
Practice Address - Zip Code:13760-5457
Practice Address - Country:US
Practice Address - Phone:607-239-5766
Practice Address - Fax:607-239-5857
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006820101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health