Provider Demographics
NPI:1538200670
Name:LEONTY, MARIE NADINE (LCSW- R)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:NADINE
Last Name:LEONTY
Suffix:
Gender:F
Credentials:LCSW- R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3191 ROUTE 94
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10918-2325
Mailing Address - Country:US
Mailing Address - Phone:845-642-1892
Mailing Address - Fax:
Practice Address - Street 1:64 JEFFERSON STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-2325
Practice Address - Country:US
Practice Address - Phone:845-797-8800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY631191041C0700X
NY203394615251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00273969Medicaid
NY332014Medicare UPIN
NY00273969Medicaid