Provider Demographics
NPI:1568976454
Name:LEON, JOHN JOSEPH
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:JOSEPH
Last Name:LEON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 MARTINE AVE APT 2D
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-3426
Mailing Address - Country:US
Mailing Address - Phone:512-825-7352
Mailing Address - Fax:
Practice Address - Street 1:2024 WILLIAMSBRIDGE RD STE 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1631
Practice Address - Country:US
Practice Address - Phone:917-992-1569
Practice Address - Fax:718-329-0267
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-30
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health