| Doctor Name: | LISA ANNE LEIDECKER |
| NPI Number: | 1386755122 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC, LCADC |
| License Number: | 37LC00057200 |
| Business Practice Address: | 51 Upper Montclair Plz Suite 21 Upper Montclair, NJ - 070431343 |
| Business Phone Number: | 9735681166 |
| Business Fax Number: | 7329579119 |
| Mailing Address: | 13 Clavendon Ct, MIDDLETOWN |
| State: | NJ |
| Postal Code: | 077483533 |
| Phone Number: | 9735681166 |
| Fax Number: | |
| NPI Enumeration Date: | 08/31/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 37LC00057200 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | NJ |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |