Provider Demographics
NPI:1225887425
Name:ALLEN, LEONA SERETHA (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:LEONA
Middle Name:SERETHA
Last Name:ALLEN
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 169
Mailing Address - Street 2:
Mailing Address - City:NORMA
Mailing Address - State:NJ
Mailing Address - Zip Code:08347-0169
Mailing Address - Country:US
Mailing Address - Phone:856-265-1591
Mailing Address - Fax:
Practice Address - Street 1:1455 PINEWOOD BLVD
Practice Address - Street 2:
Practice Address - City:MAYS LANDING
Practice Address - State:NJ
Practice Address - Zip Code:08330-2068
Practice Address - Country:US
Practice Address - Phone:856-345-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-18
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ15075800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health