Organization Name: | BARRY M LEAVITT AND ASSOCIATES |
NPI Number: | 1073840484 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | BARRY M LEAVITT (PRESIDENT) |
Mailing Address: | 790 Frontage Rd Northfield |
State: | IL US |
Postal Code: | 600931204 |
Phone Number: | 8474414111 |
Fax Number: | |
NPI Enumeration Date: | 11/05/2009 |
NPI Last Update Date: | 11/09/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 071003655 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |