Provider Demographics
NPI:1760639231
Name:FRANCE, LEON (CASAC)
Entity Type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:FRANCE
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-1335
Mailing Address - Country:US
Mailing Address - Phone:315-788-1530
Mailing Address - Fax:315-788-3794
Practice Address - Street 1:24180 COUNTY ROUTE 16
Practice Address - Street 2:
Practice Address - City:EVANS MILLS
Practice Address - State:NY
Practice Address - Zip Code:13637-3127
Practice Address - Country:US
Practice Address - Phone:315-629-4441
Practice Address - Fax:315-629-5473
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02921011Medicaid