Provider Demographics
NPI:1386883882
Name:PHILLIPS, LEONARD R (MSW, LCSW-R)
Entity type:Individual
Prefix:
First Name:LEONARD
Middle Name:R
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MSW, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 REED ST
Mailing Address - Street 2:
Mailing Address - City:MARCELLUS
Mailing Address - State:NY
Mailing Address - Zip Code:13108-1128
Mailing Address - Country:US
Mailing Address - Phone:315-673-0840
Mailing Address - Fax:315-673-0840
Practice Address - Street 1:36 REED ST
Practice Address - Street 2:
Practice Address - City:MARCELLUS
Practice Address - State:NY
Practice Address - Zip Code:13108-1128
Practice Address - Country:US
Practice Address - Phone:315-673-0840
Practice Address - Fax:315-673-0840
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-07
Last Update Date:2009-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018434101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)