Provider Demographics
NPI:1710505284
Name:GREENLEAF, ALFRED LEVI JR
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:LEVI
Last Name:GREENLEAF
Suffix:JR
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:PO BOX 3032
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06011-3032
Mailing Address - Country:US
Mailing Address - Phone:860-620-2674
Mailing Address - Fax:
Practice Address - Street 1:51 MAHEU ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-3051
Practice Address - Country:US
Practice Address - Phone:860-620-2674
Practice Address - Fax:860-584-4612
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-10
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)