Provider Demographics
NPI:1831257351
Name:LEYNGOLD, MIKHAIL (LMSW)
Entity type:Individual
Prefix:
First Name:MIKHAIL
Middle Name:
Last Name:LEYNGOLD
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 E 9TH ST
Mailing Address - Street 2:APT 3B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-2844
Mailing Address - Country:US
Mailing Address - Phone:718-421-7397
Mailing Address - Fax:
Practice Address - Street 1:2020 CONEY ISLAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2329
Practice Address - Country:US
Practice Address - Phone:718-676-4280
Practice Address - Fax:718-676-4299
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0718881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical