Provider Demographics
NPI:1245718204
Name:MASELLI, LEAH A (PSYD)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:A
Last Name:MASELLI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 NICHOL AVE
Mailing Address - Street 2:
Mailing Address - City:NEW BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08901-2890
Mailing Address - Country:US
Mailing Address - Phone:848-932-7884
Mailing Address - Fax:732-932-2213
Practice Address - Street 1:61 NICHOL AVE
Practice Address - Street 2:
Practice Address - City:NEW BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08901
Practice Address - Country:US
Practice Address - Phone:848-932-7884
Practice Address - Fax:732-932-2213
Is Sole Proprietor?:No
Enumeration Date:2018-08-01
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022810103T00000X
NJ173-064103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist