Provider Demographics
NPI:1841893229
Name:LONEGAN, LEAH MARIE (RBT)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:LONEGAN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11706 E JENNY CIR
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-9358
Mailing Address - Country:US
Mailing Address - Phone:203-695-4545
Mailing Address - Fax:
Practice Address - Street 1:11706 E JENNY CIR
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-9358
Practice Address - Country:US
Practice Address - Phone:203-695-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician