Provider Demographics
NPI:1689022667
Name:BAITLER, LEIGH (PSYD)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:
Last Name:BAITLER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E 77TH ST APT 24A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-2490
Mailing Address - Country:US
Mailing Address - Phone:917-533-3534
Mailing Address - Fax:
Practice Address - Street 1:137 E 36TH ST STE 1L
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3528
Practice Address - Country:US
Practice Address - Phone:917-533-3534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68-016853103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical