Provider Demographics
NPI:1710434071
Name:LEITE, AMORA F
Entity Type:Individual
Prefix:
First Name:AMORA
Middle Name:F
Last Name:LEITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 TROUSDALE DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-4584
Mailing Address - Country:US
Mailing Address - Phone:415-209-4859
Mailing Address - Fax:
Practice Address - Street 1:4623 TROUSDALE DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-4584
Practice Address - Country:US
Practice Address - Phone:615-301-8431
Practice Address - Fax:615-301-8469
Is Sole Proprietor?:No
Enumeration Date:2016-09-03
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X, 101YP2500X
CAIMF103785106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist