Provider Demographics
NPI:1942676218
Name:HALLOW, LEAH ESTHER- SIMONE (PSY D)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:ESTHER- SIMONE
Last Name:HALLOW
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 5TH AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-3482
Mailing Address - Country:US
Mailing Address - Phone:518-687-1960
Mailing Address - Fax:518-687-1970
Practice Address - Street 1:2001 5TH AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-3482
Practice Address - Country:US
Practice Address - Phone:518-687-1960
Practice Address - Fax:518-687-1970
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020844103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist