Provider Demographics
NPI:1578001632
Name:LEYRO, THERESA MARIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:MARIA
Last Name:LEYRO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:MARIA
Other - Last Name:LEYRO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:56 BYRAM SHORE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-6927
Mailing Address - Country:US
Mailing Address - Phone:617-223-1024
Mailing Address - Fax:
Practice Address - Street 1:56 BYRAM SHORE RD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-6927
Practice Address - Country:US
Practice Address - Phone:617-223-1024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-08
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X, 103TA0400X, 103TB0200X, 103TC2200X, 103TH0004X, 103TP2701X
NY021969103TB0200X
NJ35SI00528100103TC0700X
NY021969-1103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy