Provider Demographics
NPI:1295582864
Name:DIGARD, LEON (LP)
Entity type:Individual
Prefix:
First Name:LEON
Middle Name:
Last Name:DIGARD
Suffix:
Gender:M
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 CLASSON AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-4688
Mailing Address - Country:US
Mailing Address - Phone:917-617-6441
Mailing Address - Fax:
Practice Address - Street 1:764 CLASSON AVE APT 8
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-4688
Practice Address - Country:US
Practice Address - Phone:917-617-6441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001209102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst