Provider Demographics
NPI:1700270147
Name:DELEON, JOVANA (LMSW)
Entity Type:Individual
Prefix:
First Name:JOVANA
Middle Name:
Last Name:DELEON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 SUYDAM PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-3014
Mailing Address - Country:US
Mailing Address - Phone:678-472-2683
Mailing Address - Fax:
Practice Address - Street 1:10 SUYDAM PL
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-3014
Practice Address - Country:US
Practice Address - Phone:678-472-2683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094410-1172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker