Provider Demographics
NPI:1609383348
Name:LEIT PSYCHOTHERAPY LLC
Entity Type:Organization
Organization Name:LEIT PSYCHOTHERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEIT
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:201-207-0376
Mailing Address - Street 1:318 MAIN ST STE 200A
Mailing Address - Street 2:
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041-1181
Mailing Address - Country:US
Mailing Address - Phone:201-207-0376
Mailing Address - Fax:
Practice Address - Street 1:318 MAIN ST STE 200A
Practice Address - Street 2:
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041-1181
Practice Address - Country:US
Practice Address - Phone:201-207-0376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-03
Last Update Date:2018-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051409001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty