Provider Demographics
NPI:1184640625
Name:MARCIA B LEDER PHD PA
Entity Type:Organization
Organization Name:MARCIA B LEDER PHD PA
Other - Org Name:WEST BOCA PSYCHOLOGY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:LEDER
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:561-482-8072
Mailing Address - Street 1:22047 STATE RD 7
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428
Mailing Address - Country:US
Mailing Address - Phone:561-482-8072
Mailing Address - Fax:561-482-7571
Practice Address - Street 1:22047 STATE RD 7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428
Practice Address - Country:US
Practice Address - Phone:561-482-8072
Practice Address - Fax:561-482-7571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4123103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
R03913Medicare UPIN
73463Medicare ID - Type Unspecified