Provider Demographics
NPI:1770676272
Name:MONROE, LEROY V (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:V
Last Name:MONROE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 SPRAGUE ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1427
Mailing Address - Country:US
Mailing Address - Phone:516-297-7712
Mailing Address - Fax:516-623-7060
Practice Address - Street 1:BALDWIN MEDICAL PLAZA
Practice Address - Street 2:865 MERRICK ROAD, SUITE #305
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510
Practice Address - Country:US
Practice Address - Phone:516-868-3421
Practice Address - Fax:516-623-7060
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008773101YA0400X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01572229Medicaid
NYV08971Medicare ID - Type Unspecified