Provider Demographics
NPI:1295941276
Name:MARYANN LEIFER PSYD PA
Entity type:Organization
Organization Name:MARYANN LEIFER PSYD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIFER
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:561-738-0993
Mailing Address - Street 1:8190 JOG RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437
Mailing Address - Country:US
Mailing Address - Phone:561-738-0993
Mailing Address - Fax:561-734-7243
Practice Address - Street 1:8190 JOG RD
Practice Address - Street 2:SUITE 220
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437
Practice Address - Country:US
Practice Address - Phone:561-738-0993
Practice Address - Fax:561-734-7243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4159103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
K9218Medicare ID - Type Unspecified