Provider Demographics
NPI:1134335417
Name:LEINWAND, KENNETH JEFFREY
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:JEFFREY
Last Name:LEINWAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AMERICAN CONSULATE GENERAL JERUSAELM
Mailing Address - Street 2:PSC 98 BOX 39
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09830
Mailing Address - Country:US
Mailing Address - Phone:0119725-441-7307
Mailing Address - Fax:
Practice Address - Street 1:25 HAYARKON STREET
Practice Address - Street 2:
Practice Address - City:JERUSAELM
Practice Address - State:ISRAEL
Practice Address - Zip Code:94512
Practice Address - Country:IL
Practice Address - Phone:01197254-441-7307
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2113106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist