Provider Demographics
NPI:1922770981
Name:LEFFINGWELL, TAETUM M
Entity Type:Individual
Prefix:
First Name:TAETUM
Middle Name:M
Last Name:LEFFINGWELL
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 1:72 FAIRLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1744
Mailing Address - Country:US
Mailing Address - Phone:315-884-2979
Mailing Address - Fax:
Practice Address - Street 1:9221 ROBERT HART DR
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-8931
Practice Address - Country:US
Practice Address - Phone:585-335-4316
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health