Provider Demographics
NPI:1740082296
Name:LEAD BY EXAMPLE, REVERSE THE TREND
Entity type:Organization
Organization Name:LEAD BY EXAMPLE, REVERSE THE TREND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:HENDRICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-430-9020
Mailing Address - Street 1:8 W 126TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10027-3811
Mailing Address - Country:US
Mailing Address - Phone:732-430-9020
Mailing Address - Fax:
Practice Address - Street 1:2916 8TH AVE STE 2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-1619
Practice Address - Country:US
Practice Address - Phone:732-430-9020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health