Provider Demographics
NPI:1871750265
Name:LEONARD, J KEVIN (CASAC)
Entity type:Individual
Prefix:
First Name:J
Middle Name:KEVIN
Last Name:LEONARD
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6100
Mailing Address - Street 2:BLDG #16 N COUNTY COMPLEX SUFFOLK CNTY DEPT OF HEALTH
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788
Mailing Address - Country:US
Mailing Address - Phone:631-853-6281
Mailing Address - Fax:631-853-6254
Practice Address - Street 1:BLDG #16 N COUNTY COMPLEX
Practice Address - Street 2:SUFFOLK CNTY DEPT OF HEALTH DAY REPORTING CENTER
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788
Practice Address - Country:US
Practice Address - Phone:631-853-6281
Practice Address - Fax:631-853-6254
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY7169101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)