Provider Demographics
NPI:1821047002
Name:LEUCI, ERNEST (LCSWR)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:
Last Name:LEUCI
Suffix:
Gender:M
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PREMIER CT
Mailing Address - Street 2:
Mailing Address - City:PRT JEFF STA
Mailing Address - State:NY
Mailing Address - Zip Code:11776-3198
Mailing Address - Country:US
Mailing Address - Phone:631-476-7119
Mailing Address - Fax:
Practice Address - Street 1:3 PREMIER CT
Practice Address - Street 2:
Practice Address - City:PRT JEFF STA
Practice Address - State:NY
Practice Address - Zip Code:11776-3198
Practice Address - Country:US
Practice Address - Phone:631-476-7119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR053666-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN5G941Medicare PIN