Provider Demographics
NPI:1386420651
Name:LEONE, JEREMY TAYLOR (LCSW)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:TAYLOR
Last Name:LEONE
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 TAYLOR AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-2065
Mailing Address - Country:US
Mailing Address - Phone:203-984-9595
Mailing Address - Fax:
Practice Address - Street 1:84 TAYLOR AVE APT 2
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-2065
Practice Address - Country:US
Practice Address - Phone:203-984-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT13321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical