Provider Demographics
NPI:1376318733
Name:LEYBOVSKY, KATRINA (BCBA)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:LEYBOVSKY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:LEYBOVSKY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BCBA
Mailing Address - Street 1:137 ETHAN ALLEN HWY
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-6238
Mailing Address - Country:US
Mailing Address - Phone:203-464-9053
Mailing Address - Fax:
Practice Address - Street 1:137 ETHAN ALLEN HWY
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-6238
Practice Address - Country:US
Practice Address - Phone:203-464-9053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1793103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst