Provider Demographics
NPI:1619174349
Name:LEBOR, ANNETTE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:LEBOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANNETTE
Other - Middle Name:
Other - Last Name:LEBOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:999 CENTRAL AVE
Mailing Address - Street 2:SUITE 207
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-1205
Mailing Address - Country:US
Mailing Address - Phone:516-382-2684
Mailing Address - Fax:718-301-9053
Practice Address - Street 1:999 CENTRAL AVE
Practice Address - Street 2:SUITE 207
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-1205
Practice Address - Country:US
Practice Address - Phone:516-382-2684
Practice Address - Fax:718-301-9053
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR-045045-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health