Provider Demographics
NPI:1942864145
Name:CYNTHIA LEAVITT, LLC
Entity Type:Organization
Organization Name:CYNTHIA LEAVITT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC, ATR
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-670-0507
Mailing Address - Street 1:39 NEW LONDON TPKE STE 316
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2061
Mailing Address - Country:US
Mailing Address - Phone:860-670-0507
Mailing Address - Fax:
Practice Address - Street 1:39 NEW LONDON TPKE STE 316
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2061
Practice Address - Country:US
Practice Address - Phone:860-670-0507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health