Provider Demographics
NPI:1922163526
Name:LEEDS, JOSEPH NATHANIEL (LCSW-R)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:NATHANIEL
Last Name:LEEDS
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 E 188TH ST FL 4
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5302
Mailing Address - Country:US
Mailing Address - Phone:718-960-0427
Mailing Address - Fax:
Practice Address - Street 1:260 E 188TH ST FL 4
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5302
Practice Address - Country:US
Practice Address - Phone:718-960-0427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0711391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical