Provider Demographics
NPI:1649407784
Name:LEON, LISSETTE ALEJANDRA (MD)
Entity Type:Individual
Prefix:
First Name:LISSETTE
Middle Name:ALEJANDRA
Last Name:LEON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14 HARWOOD CT
Mailing Address - Street 2:SUITE 303
Mailing Address - City:SCARSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10583-4121
Mailing Address - Country:US
Mailing Address - Phone:914-620-2173
Mailing Address - Fax:866-884-3385
Practice Address - Street 1:14 HARWOOD CT
Practice Address - Street 2:SUITE 303
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-4121
Practice Address - Country:US
Practice Address - Phone:914-620-2173
Practice Address - Fax:866-884-3385
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2563772084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry