Provider Demographics
NPI:1821057811
Name:PERONE, LEONIS MARIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LEONIS
Middle Name:MARIE
Last Name:PERONE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 BUTTONWOOD ST
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-4231
Mailing Address - Country:US
Mailing Address - Phone:610-639-1158
Mailing Address - Fax:610-272-4501
Practice Address - Street 1:1717 SWEDE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-3375
Practice Address - Country:US
Practice Address - Phone:610-639-1158
Practice Address - Fax:610-272-4501
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0127151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA644326KBJMedicare ID - Type Unspecified