Provider Demographics
NPI:1386497956
Name:LEONELLO, ANNETTE (CASAC)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:LEONELLO
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 BRIGHTON HENRIETTA TOWN LINE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-2532
Mailing Address - Country:US
Mailing Address - Phone:585-287-5622
Mailing Address - Fax:
Practice Address - Street 1:1850 BRIGHTON HENRIETTA TOWN LINE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-2532
Practice Address - Country:US
Practice Address - Phone:585-287-5622
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY36208101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)