Provider Demographics
NPI:1720265242
Name:AVATO, LEANDRA KATHERINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:LEANDRA
Middle Name:KATHERINE
Last Name:AVATO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 STRATHMORE TER
Mailing Address - Street 2:
Mailing Address - City:SADDLE BROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07663-4417
Mailing Address - Country:US
Mailing Address - Phone:201-647-4545
Mailing Address - Fax:
Practice Address - Street 1:15 STRATHMORE TER
Practice Address - Street 2:
Practice Address - City:SADDLE BROOK
Practice Address - State:NJ
Practice Address - Zip Code:07663-4417
Practice Address - Country:US
Practice Address - Phone:201-647-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 8857101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSW 8857OtherDEPARTMENT OF HEALTH