Provider Demographics
NPI:1174339105
Name:MCLEOD, JEQUINNA LARIN
Entity type:Individual
Prefix:
First Name:JEQUINNA
Middle Name:LARIN
Last Name:MCLEOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 LINCOLN TER
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-3903
Mailing Address - Country:US
Mailing Address - Phone:914-382-6301
Mailing Address - Fax:
Practice Address - Street 1:341 TRINITY ST
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1234
Practice Address - Country:US
Practice Address - Phone:516-229-1194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-04
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003922103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst