Provider Demographics
NPI:1306235551
Name:LEANDRE, ROSE
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:LEANDRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WARD LN
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:NY
Mailing Address - Zip Code:10977-3028
Mailing Address - Country:US
Mailing Address - Phone:845-517-9881
Mailing Address - Fax:
Practice Address - Street 1:3 WARD LN
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10977-3028
Practice Address - Country:US
Practice Address - Phone:845-517-9881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No171R00000XOther Service ProvidersInterpreter
No251X00000XAgenciesSupports Brokerage