Provider Demographics
NPI:1245809284
Name:LEBRON, ADAM
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:LEBRON
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 1:81 RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-1023
Mailing Address - Country:US
Mailing Address - Phone:347-898-9736
Mailing Address - Fax:
Practice Address - Street 1:81 RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-1023
Practice Address - Country:US
Practice Address - Phone:347-898-9736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Single Specialty