Provider Demographics
NPI:1598054272
Name:LEATHERMAN, BETH (LAC)
Entity Type:Individual
Prefix:MS
First Name:BETH
Middle Name:
Last Name:LEATHERMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Mailing Address - Street 1:261 BLACK RIVER RD
Mailing Address - Street 2:
Mailing Address - City:LONG VALLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07853-3067
Mailing Address - Country:US
Mailing Address - Phone:646-691-7482
Mailing Address - Fax:908-852-1402
Practice Address - Street 1:176 MOUNTAIN AVE STE 2B
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2434
Practice Address - Country:US
Practice Address - Phone:908-850-1400
Practice Address - Fax:908-852-1402
Is Sole Proprietor?:No
Enumeration Date:2011-04-01
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004528171100000X
NJ25MZ00091300171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist