Provider Demographics
NPI:1902154560
Name:WELNER, LEORA (MS, MA)
Entity Type:Individual
Prefix:MS
First Name:LEORA
Middle Name:
Last Name:WELNER
Suffix:
Gender:F
Credentials:MS, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 EAST 90TH ST.
Mailing Address - Street 2:#2C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:917-617-8816
Mailing Address - Fax:
Practice Address - Street 1:125 EAST 90TH ST.
Practice Address - Street 2:#2C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:917-617-8816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY362367031171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor