Provider Demographics
NPI:1518416445
Name:GARVEY, LEAH MICHELLE
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MICHELLE
Last Name:GARVEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:626 FLATBUSH AVE
Mailing Address - Street 2:APT 4L
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-1055
Mailing Address - Country:US
Mailing Address - Phone:617-620-3345
Mailing Address - Fax:
Practice Address - Street 1:626 FLATBUSH AVE
Practice Address - Street 2:APT 4L
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-1055
Practice Address - Country:US
Practice Address - Phone:617-620-3345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098643174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist