Provider Demographics
NPI:1578373767
Name:LEADER, GRACE ANNE (MHC-LP)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:ANNE
Last Name:LEADER
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 WOODLAKE RD APT 1
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-3973
Mailing Address - Country:US
Mailing Address - Phone:516-670-6971
Mailing Address - Fax:
Practice Address - Street 1:6 WELLNESS WAY
Practice Address - Street 2:
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110-2156
Practice Address - Country:US
Practice Address - Phone:518-782-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-09
Last Update Date:2025-01-30
Deactivation Date:2025-01-09
Deactivation Code:
Reactivation Date:2025-01-30
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health