Provider Demographics
NPI:1023037595
Name:LEEDS, JANICE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:
Last Name:LEEDS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MUSTANG TRL
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:NJ
Mailing Address - Zip Code:07059-6914
Mailing Address - Country:US
Mailing Address - Phone:732-764-0289
Mailing Address - Fax:732-764-0265
Practice Address - Street 1:9 MUSTANG TRL
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-6914
Practice Address - Country:US
Practice Address - Phone:732-764-0289
Practice Address - Fax:732-764-0265
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2957103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist