Provider Demographics
NPI:1083008312
Name:JUDYTH A. LEAVITT PSYCHOTHERAPIST P.L.L.C.
Entity Type:Organization
Organization Name:JUDYTH A. LEAVITT PSYCHOTHERAPIST P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JUDYTH
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-903-2122
Mailing Address - Street 1:PO BOX 384
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-0384
Mailing Address - Country:US
Mailing Address - Phone:603-903-2122
Mailing Address - Fax:
Practice Address - Street 1:100 EMERALD ST
Practice Address - Street 2:STE C
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3610
Practice Address - Country:US
Practice Address - Phone:603-903-2122
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0631101YA0400X
NH15141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty