Provider Demographics
NPI:1588135685
Name:ULYSSE, LEONIE
Entity type:Individual
Prefix:
First Name:LEONIE
Middle Name:
Last Name:ULYSSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SOBRO AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2323
Mailing Address - Country:US
Mailing Address - Phone:516-459-6784
Mailing Address - Fax:516-792-5632
Practice Address - Street 1:112 SOBRO AVE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2323
Practice Address - Country:US
Practice Address - Phone:516-459-6784
Practice Address - Fax:516-792-5632
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105043-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker