Provider Demographics
NPI:1942610548
Name:LEITER, INNA MARKUS (PSYD)
Entity Type:Individual
Prefix:
First Name:INNA
Middle Name:MARKUS
Last Name:LEITER
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 1:5 EBIE CIR
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2247
Mailing Address - Country:US
Mailing Address - Phone:215-356-9905
Mailing Address - Fax:
Practice Address - Street 1:323 E FRONT ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3036
Practice Address - Country:US
Practice Address - Phone:267-551-1984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-05
Last Update Date:2018-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist