Provider Demographics
NPI:1558142661
Name:NGUYEN, LEA (MHC-LP)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4013 50TH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3129
Mailing Address - Country:US
Mailing Address - Phone:516-782-4467
Mailing Address - Fax:
Practice Address - Street 1:150 E 58TH ST FL 21
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10155-0002
Practice Address - Country:US
Practice Address - Phone:516-229-1360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP125130101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health