Provider Demographics
NPI:1922338862
Name:LEONARD-JEAN CHARLES, ANTOINETTE (CD, LCCE)
Entity Type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:
Last Name:LEONARD-JEAN CHARLES
Suffix:
Gender:F
Credentials:CD, LCCE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 CONEY ISLAND AVE
Mailing Address - Street 2:APT 1
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-4340
Mailing Address - Country:US
Mailing Address - Phone:646-763-7865
Mailing Address - Fax:
Practice Address - Street 1:667 CONEY ISLAND AVE
Practice Address - Street 2:APT 1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-4340
Practice Address - Country:US
Practice Address - Phone:646-763-7865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-26
Last Update Date:2009-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY71029174H00000X
NY6108374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No174H00000XOther Service ProvidersHealth Educator