Provider Demographics
NPI:1396800801
Name:LEAK, SHARON (PHD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:LEAK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 MURRAY AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-2352
Mailing Address - Country:US
Mailing Address - Phone:412-422-3470
Mailing Address - Fax:412-422-3770
Practice Address - Street 1:2345 MURRAY AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-2352
Practice Address - Country:US
Practice Address - Phone:412-422-3470
Practice Address - Fax:412-422-3770
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006794L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PALE070631OtherBLUE SHIELD