Provider Demographics
NPI:1114900701
Name:LELAND, LAUREL A (MS)
Entity Type:Individual
Prefix:MS
First Name:LAUREL
Middle Name:A
Last Name:LELAND
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1460 DARTMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-9146
Mailing Address - Country:US
Mailing Address - Phone:610-861-7580
Mailing Address - Fax:
Practice Address - Street 1:1250 GREENWOOD DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-3677
Practice Address - Country:US
Practice Address - Phone:610-868-1577
Practice Address - Fax:610-868-8834
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005828-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5108295OtherAETNA
PA02021702OtherCAPITAL BLUE CROSS