Provider Demographics
NPI:1649417510
Name:LEON TEC
Entity type:Organization
Organization Name:LEON TEC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SOPHIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CARLSSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-322-1479
Mailing Address - Street 1:11 ROCKYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-2202
Mailing Address - Country:US
Mailing Address - Phone:203-227-1331
Mailing Address - Fax:203-227-2439
Practice Address - Street 1:11 ROCKYFIELD RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-2202
Practice Address - Country:US
Practice Address - Phone:203-227-1331
Practice Address - Fax:203-227-2439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT09529251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT260000153Other060862585