Provider Demographics
NPI:1467787796
Name:LEICHT, LEAH KAFENBAUM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:KAFENBAUM
Last Name:LEICHT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:LEAH
Other - Middle Name:
Other - Last Name:KAFENBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25 BERGEN ST
Mailing Address - Street 2:2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-8620
Mailing Address - Country:US
Mailing Address - Phone:917-855-7741
Mailing Address - Fax:
Practice Address - Street 1:641 PRESIDENT ST
Practice Address - Street 2:SUITE 101
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-1523
Practice Address - Country:US
Practice Address - Phone:718-635-1525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-05
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68018864103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist