Provider Demographics
NPI:1962557595
Name:LEONE, GEORGE (PHD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:
Last Name:LEONE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 165
Mailing Address - Street 2:
Mailing Address - City:SERAFINA
Mailing Address - State:NM
Mailing Address - Zip Code:87569-0165
Mailing Address - Country:US
Mailing Address - Phone:505-429-9217
Mailing Address - Fax:
Practice Address - Street 1:2301 COLLINS DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NM
Practice Address - Zip Code:87701-4826
Practice Address - Country:US
Practice Address - Phone:505-425-9362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0395101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM000069Medicaid