Provider Demographics
NPI:1578820098
Name:LEOPOLD, JENNIFER LYNN (LMSW, IBCLC, LLLL)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYNN
Last Name:LEOPOLD
Suffix:
Gender:F
Credentials:LMSW, IBCLC, LLLL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 E 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2514
Mailing Address - Country:US
Mailing Address - Phone:718-339-3806
Mailing Address - Fax:
Practice Address - Street 1:1827 E 28TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-2514
Practice Address - Country:US
Practice Address - Phone:718-339-3806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-22
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058531-1104100000X
NY11127028174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No174N00000XOther Service ProvidersLactation Consultant, Non-RN