Provider Demographics
NPI:1518604834
Name:HARRAKA, LEAH ALEXIS
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ALEXIS
Last Name:HARRAKA
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 1:21 PINE DR
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07656-1816
Mailing Address - Country:US
Mailing Address - Phone:201-726-7917
Mailing Address - Fax:
Practice Address - Street 1:48 S FRANKLIN TPKE STE 101
Practice Address - Street 2:
Practice Address - City:RAMSEY
Practice Address - State:NJ
Practice Address - Zip Code:07446-2558
Practice Address - Country:US
Practice Address - Phone:201-786-6280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ12257833103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst