Provider Demographics
NPI:1942892617
Name:LEUNG, ROSE (PSYD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:LEUNG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12225 REGAL SPRINGS CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89138-1121
Mailing Address - Country:US
Mailing Address - Phone:631-291-2825
Mailing Address - Fax:
Practice Address - Street 1:231 NORMAN AVE STE 314
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-1559
Practice Address - Country:US
Practice Address - Phone:631-291-2825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011077103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist