Provider Demographics
NPI:1740428333
Name:LEATHERBERY, SCOTT W (PHD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:W
Last Name:LEATHERBERY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 E END AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1307
Mailing Address - Country:US
Mailing Address - Phone:412-860-3275
Mailing Address - Fax:
Practice Address - Street 1:1129 E END AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1307
Practice Address - Country:US
Practice Address - Phone:412-860-3275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006000L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical