Provider Demographics
NPI:1295884849
Name:ENNIS, LEROY (LCSW)
Entity type:Individual
Prefix:MR
First Name:LEROY
Middle Name:
Last Name:ENNIS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 GLENCAR AVE
Mailing Address - Street 2:APT. 40
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-2337
Mailing Address - Country:US
Mailing Address - Phone:914-237-6089
Mailing Address - Fax:914-237-6099
Practice Address - Street 1:705 BRONX RIVER RD STE 204
Practice Address - Street 2:C/O WJCS - FAMILY MATTERS PROGRAM
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10704-1752
Practice Address - Country:US
Practice Address - Phone:914-237-6089
Practice Address - Fax:914-237-6099
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079975104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker