Provider Demographics
NPI:1972791358
Name:LEIBSOHN, MATTHEW TODD (PHD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:TODD
Last Name:LEIBSOHN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 74TH PL SE
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3400
Mailing Address - Country:US
Mailing Address - Phone:425-453-7722
Mailing Address - Fax:425-320-1021
Practice Address - Street 1:1450 114TH AVE SE
Practice Address - Street 2:STE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6962
Practice Address - Country:US
Practice Address - Phone:425-453-7722
Practice Address - Fax:425-320-1021
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1764103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling