Provider Demographics
NPI:1124856562
Name:DE LEON, MEGAN (LMSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:DE LEON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BERKELEY HILL DR APT 901
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-1087
Mailing Address - Country:US
Mailing Address - Phone:917-870-0757
Mailing Address - Fax:
Practice Address - Street 1:1457 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3003
Practice Address - Country:US
Practice Address - Phone:516-520-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119984104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker