Provider Demographics
NPI:1558791087
Name:LEAFGREEN, MANJOT DHOOPER (PHD)
Entity Type:Individual
Prefix:DR
First Name:MANJOT
Middle Name:DHOOPER
Last Name:LEAFGREEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:MANJOT
Other - Middle Name:KAUR
Other - Last Name:DHOOPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1821 BUSINESS PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1230
Mailing Address - Country:US
Mailing Address - Phone:386-366-6700
Mailing Address - Fax:
Practice Address - Street 1:1821 BUSINESS PARK BLVD
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1230
Practice Address - Country:US
Practice Address - Phone:386-366-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-19
Last Update Date:2014-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 8213103TC0700X
SD457103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical