Provider Demographics
NPI:1588721252
Name:LEROY, NICHOLAS L (MED)
Entity type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:L
Last Name:LEROY
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 YELLOW PINE RD
Mailing Address - Street 2:
Mailing Address - City:BUZZARDS BAY
Mailing Address - State:MA
Mailing Address - Zip Code:02532
Mailing Address - Country:US
Mailing Address - Phone:508-801-7580
Mailing Address - Fax:
Practice Address - Street 1:61 INDUSTRIAL PARK RD
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360
Practice Address - Country:US
Practice Address - Phone:508-830-0000
Practice Address - Fax:508-746-8424
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health