| Doctor Name: | MRS. LINDA L LEAVENS |
| NPI Number: | 1962776153 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, LCSW, CASAC |
| License Number: | 16940 |
| Business Practice Address: | 166 Lord Howe St. Ticonderoga, NY - 12883 |
| Business Phone Number: | 5185866568 |
| Business Fax Number: | 5185853265 |
| Mailing Address: | 166 Lord Howe St., TICONDEROGA |
| State: | NY |
| Postal Code: | 12883 |
| Phone Number: | 5185866568 |
| Fax Number: | 5185853265 |
| NPI Enumeration Date: | 03/06/2012 |
| NPI Last Update Date: | 11/30/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 16940 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |