Provider Demographics
NPI:1265648315
Name:LEAVY, BARBARA GODOFSKY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:GODOFSKY
Last Name:LEAVY
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 1:718 CANTOR TRL
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-3960
Mailing Address - Country:US
Mailing Address - Phone:856-905-5244
Mailing Address - Fax:
Practice Address - Street 1:36 TANNER ROAD
Practice Address - Street 2:SUITE 120
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2494
Practice Address - Country:US
Practice Address - Phone:856-448-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2016-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010340-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical