Provider Demographics
NPI:1689795387
Name:LEPORE, ANNE-MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE-MARIE
Middle Name:
Last Name:LEPORE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANNE-MARIE
Other - Middle Name:
Other - Last Name:DONOVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3847 LEE DR
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11783-1562
Mailing Address - Country:US
Mailing Address - Phone:917-670-2875
Mailing Address - Fax:
Practice Address - Street 1:3847 LEE DR
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:NY
Practice Address - Zip Code:11783-1562
Practice Address - Country:US
Practice Address - Phone:917-670-2875
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016124103G00000X, 103T00000X, 103TC0700X, 103TH0100X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities