Provider Demographics
NPI:1134521842
Name:LEACH, TANYA LYNNE (JD, LP, NCPSYA)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:LYNNE
Last Name:LEACH
Suffix:
Gender:
Credentials:JD, LP, NCPSYA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W 57TH ST STE 711
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2302
Mailing Address - Country:US
Mailing Address - Phone:212-567-2287
Mailing Address - Fax:914-455-0906
Practice Address - Street 1:119 W 57TH ST STE 711
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-2302
Practice Address - Country:US
Practice Address - Phone:212-567-2287
Practice Address - Fax:914-455-0906
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-24
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001054102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst