Provider Demographics
NPI:1013034826
Name:LEISENRING, DENNIS KEITH (PSY D)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:KEITH
Last Name:LEISENRING
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:166 GOLD BROOK CIR
Mailing Address - Street 2:
Mailing Address - City:STOWE
Mailing Address - State:VT
Mailing Address - Zip Code:05672-4535
Mailing Address - Country:US
Mailing Address - Phone:802-253-8498
Mailing Address - Fax:802-253-7332
Practice Address - Street 1:234 MAPLE ST
Practice Address - Street 2:BOX 849
Practice Address - City:STOWE
Practice Address - State:VT
Practice Address - Zip Code:05672-4248
Practice Address - Country:US
Practice Address - Phone:802-253-7337
Practice Address - Fax:802-253-7332
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000144101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)