Provider Demographics
NPI:1972128171
Name:LEO, JESSICA (MS, LCADC)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:LEO
Suffix:
Gender:F
Credentials:MS, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SOUTH ST APT 10L
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6060
Mailing Address - Country:US
Mailing Address - Phone:973-769-6661
Mailing Address - Fax:
Practice Address - Street 1:320 SOUTH ST APT 10L
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6060
Practice Address - Country:US
Practice Address - Phone:973-769-6661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00301500101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)