Provider Demographics
NPI:1457468449
Name:EMBRY, LEANNE MARIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEANNE
Middle Name:MARIE
Last Name:EMBRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LEANNE
Other - Middle Name:EMBRY
Other - Last Name:SEGOVIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:333 N. SANTA ROSA STREET, 8TH FLOOR
Mailing Address - Street 2:UTHSCSA, PEDIATRIC HEMATOLOGY/ONCOLOGY
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207
Mailing Address - Country:US
Mailing Address - Phone:210-704-2987
Mailing Address - Fax:210-704-2396
Practice Address - Street 1:333 N. SANTA ROSA STREET, 8TH FLOOR
Practice Address - Street 2:UTHSCSA, PEDIATRIC HEMATOLOGY/ONCOLOGY
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207
Practice Address - Country:US
Practice Address - Phone:210-704-2987
Practice Address - Fax:210-704-2396
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31709103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176142103Medicaid
TX176142103Medicaid