Provider Demographics
NPI:1811037765
Name:LEITNER, DONNA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:DONNA
Middle Name:L
Last Name:LEITNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STROUDSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:18360-1590
Mailing Address - Country:US
Mailing Address - Phone:570-236-4966
Mailing Address - Fax:
Practice Address - Street 1:134 BROAD ST
Practice Address - Street 2:
Practice Address - City:STROUDSBURG
Practice Address - State:PA
Practice Address - Zip Code:18360-1590
Practice Address - Country:US
Practice Address - Phone:570-236-4966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PALE1448078103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist