Provider Demographics
NPI:1114187390
Name:LEANNE DOMASH, PH.D., P.C.
Entity Type:Organization
Organization Name:LEANNE DOMASH, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOMASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-982-6672
Mailing Address - Street 1:77 E 12TH ST
Mailing Address - Street 2:#19D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-5002
Mailing Address - Country:US
Mailing Address - Phone:212-982-6672
Mailing Address - Fax:
Practice Address - Street 1:77 E 12TH ST
Practice Address - Street 2:#19D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-5002
Practice Address - Country:US
Practice Address - Phone:212-982-6672
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY#4388103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty