Provider Demographics
NPI:1184077448
Name:LE, JONATHAN A (BS)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:A
Last Name:LE
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4322 QUEENS ST APT 601
Mailing Address - Street 2:
Mailing Address - City:LONG ISLAND CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11101-7926
Mailing Address - Country:US
Mailing Address - Phone:917-396-2329
Mailing Address - Fax:
Practice Address - Street 1:4322 QUEENS ST APT 601
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-7926
Practice Address - Country:US
Practice Address - Phone:917-396-2329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY01135601101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health