Provider Demographics
NPI:1366505828
Name:MOSBY, LELAND DARRELL (EDD)
Entity Type:Individual
Prefix:DR
First Name:LELAND
Middle Name:DARRELL
Last Name:MOSBY
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 BROWNING LN
Mailing Address - Street 2:BLDG C, SUITE 5
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-3195
Mailing Address - Country:US
Mailing Address - Phone:856-857-0881
Mailing Address - Fax:
Practice Address - Street 1:102 BROWNING LN
Practice Address - Street 2:BLDG C, SUITE 5
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-3195
Practice Address - Country:US
Practice Address - Phone:856-857-0881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000555101YM0800X
NJSI3313103TF0200X, 103TC0700X
FLMFT#1175106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist