Doctor Name: | CARYN LEISTNER |
NPI Number: | 1336205335 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, LCMHC |
License Number: | 68-495 |
Business Practice Address: | 39 Church St Hardwick, VT - 058430147 |
Business Phone Number: | 8024616113 |
Business Fax Number: | |
Mailing Address: | Po Box 182, WOODBURY |
State: | VT |
Postal Code: | 056810182 |
Phone Number: | 8024616113 |
Fax Number: | |
NPI Enumeration Date: | 12/28/2006 |
NPI Last Update Date: | 04/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 68-495 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |