Provider Demographics
NPI:1730356205
Name:LEONE, JOHN S (MA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:S
Last Name:LEONE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:16432 CHATHAM DR
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:MI
Mailing Address - Zip Code:48044-4071
Mailing Address - Country:US
Mailing Address - Phone:313-806-3316
Mailing Address - Fax:
Practice Address - Street 1:2550 S TELEGRAPH RD
Practice Address - Street 2:SUITE 240
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48302-0950
Practice Address - Country:US
Practice Address - Phone:313-806-3316
Practice Address - Fax:248-334-5810
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011038103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical