Provider Demographics
NPI:1528793528
Name:MACIEL, LEANDRO (MHC)
Entity type:Individual
Prefix:MR
First Name:LEANDRO
Middle Name:
Last Name:MACIEL
Suffix:
Gender:M
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GRAND AVE APT 5-8
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11205-1343
Mailing Address - Country:US
Mailing Address - Phone:347-661-9448
Mailing Address - Fax:
Practice Address - Street 1:15 2ND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2711
Practice Address - Country:US
Practice Address - Phone:718-514-6009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-22
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health