Organization
LEO CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARLOS MARRERO OWNER (OWNER)
(860) 992-5569
Entity
Organization
Contact information
Practice address
54 FOREST ST, HARTFORD, CT 06105-3204
(860) 992-5569
Mailing address
54 FOREST ST, HARTFORD, CT 06105-3204
(860) 992-5569
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
251S00000X
Community/Behavioral Health Agency
—
—
261QM0850X
Adult Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
06/29/2022
Last updated
06/29/2022
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