Provider Demographics
NPI:1023458296
Name:GHERARDI, LEAH ELIZABETH (SPECIAL EDUCATION)
Entity type:Individual
Prefix:MS
First Name:LEAH
Middle Name:ELIZABETH
Last Name:GHERARDI
Suffix:
Gender:F
Credentials:SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:PORT EWEN
Mailing Address - State:NY
Mailing Address - Zip Code:12466-0122
Mailing Address - Country:US
Mailing Address - Phone:845-853-6855
Mailing Address - Fax:
Practice Address - Street 1:163 SALEM STREET
Practice Address - Street 2:
Practice Address - City:PORT EWEN
Practice Address - State:NY
Practice Address - Zip Code:12466
Practice Address - Country:US
Practice Address - Phone:845-853-6855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159582021390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program