Provider Demographics
NPI:1881758548
Name:LEO-HUNEKE, DOREEN GEORGINA (LCSW)
Entity type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:GEORGINA
Last Name:LEO-HUNEKE
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 1:1110 HIDE AWAY LN
Mailing Address - Street 2:
Mailing Address - City:KODAK
Mailing Address - State:TN
Mailing Address - Zip Code:37764-2600
Mailing Address - Country:US
Mailing Address - Phone:865-850-9745
Mailing Address - Fax:865-933-6015
Practice Address - Street 1:1110 HIDE AWAY LN
Practice Address - Street 2:
Practice Address - City:KODAK
Practice Address - State:TN
Practice Address - Zip Code:37764-2600
Practice Address - Country:US
Practice Address - Phone:865-850-9745
Practice Address - Fax:865-933-6015
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN47261041C0700X
NYR052355-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515256Medicaid
TN336850OtherVALUE OPTIONS
NYP2564831OtherOXFORD INS
TN188196644OtherUNITED BEHAVIORAL HEALTH
NY275886000OtherMAGELLAN
NY7480617OtherGHI
TN4228156OtherMAGELLAN
TN1881758548OtherCIGNA
NYNY052355Other1199 SEIU N.B.F.
TN1515256OtherAMERICA CHOICE (MEDICAID)
TN1881758548OtherTRICARE
TN7495229OtherAETNA
NY336850OtherVALUE OPTIONS
NY41363POtherHIP
TN336850OtherVALUE OPTIONS
NYN0G401Medicare ID - Type Unspecified