Provider Demographics
NPI:1992921191
Name:GRIES, LEONARD T (PHD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:T
Last Name:GRIES
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 1:33 SOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:EAST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11577
Mailing Address - Country:US
Mailing Address - Phone:516-621-0036
Mailing Address - Fax:516-621-0036
Practice Address - Street 1:33 SOUTH ST.
Practice Address - Street 2:
Practice Address - City:EAST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11577
Practice Address - Country:US
Practice Address - Phone:516-621-0036
Practice Address - Fax:516-621-0036
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4419103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily