Provider Demographics
NPI:1568195717
Name:LEIDICH, JEREMY M (LSW)
Entity Type:Individual
Prefix:MR
First Name:JEREMY
Middle Name:M
Last Name:LEIDICH
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 EASTON RD
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-1419
Mailing Address - Country:US
Mailing Address - Phone:484-264-6044
Mailing Address - Fax:
Practice Address - Street 1:900 S WOODWARD ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-4179
Practice Address - Country:US
Practice Address - Phone:610-435-1541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-06
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW139364101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health