Provider Demographics
NPI:1992333454
Name:JOHNSON NGUYEN, LEYNA (LMSW, CASAC)
Entity type:Individual
Prefix:
First Name:LEYNA
Middle Name:
Last Name:JOHNSON NGUYEN
Suffix:
Gender:F
Credentials:LMSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-1075
Mailing Address - Country:US
Mailing Address - Phone:585-394-0530
Mailing Address - Fax:
Practice Address - Street 1:35 NORTH ST
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-1075
Practice Address - Country:US
Practice Address - Phone:585-394-0530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY33376101YA0400X
NY108732104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)