Provider Demographics
NPI:1184842981
Name:LEEBY, CHERALYN PAYTON (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHERALYN
Middle Name:PAYTON
Last Name:LEEBY
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 1:920 FIDDLERS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-5107
Mailing Address - Country:US
Mailing Address - Phone:904-285-1441
Mailing Address - Fax:
Practice Address - Street 1:1538 THE GREENS WAY
Practice Address - Street 2:SUITE 101
Practice Address - City:JACKSONVILLE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32250-2499
Practice Address - Country:US
Practice Address - Phone:904-543-0161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1483106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist