Provider Demographics
NPI:1306252556
Name:LEON, DARCY GRAE (RN, PMHNP)
Entity type:Individual
Prefix:MRS
First Name:DARCY
Middle Name:GRAE
Last Name:LEON
Suffix:
Gender:F
Credentials:RN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 SEAMAN AVE APT C2
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10034-1294
Mailing Address - Country:US
Mailing Address - Phone:917-436-9363
Mailing Address - Fax:
Practice Address - Street 1:254 SEAMAN AVE APT C2
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10034-1294
Practice Address - Country:US
Practice Address - Phone:917-436-9363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-09
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY672186163W00000X
NY401918363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse