Provider Demographics
NPI:1679642177
Name:LEAHY, LOIS VIRGINIA (MA, CASAC, LMHC)
Entity Type:Individual
Prefix:MS
First Name:LOIS
Middle Name:VIRGINIA
Last Name:LEAHY
Suffix:
Gender:F
Credentials:MA, CASAC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 IRVING PL
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5226
Mailing Address - Country:US
Mailing Address - Phone:845-338-1635
Mailing Address - Fax:
Practice Address - Street 1:1021 DEVELOPMENT CT
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-1959
Practice Address - Country:US
Practice Address - Phone:845-334-5323
Practice Address - Fax:845-334-5301
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002765101YM0800X
103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)