Provider Demographics
NPI:1477089456
Name:LEACH, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:LEACH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 AMHERST ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03063-1016
Mailing Address - Country:US
Mailing Address - Phone:561-323-6593
Mailing Address - Fax:
Practice Address - Street 1:81 UPPER RIVERDALE RD SW STE 110
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2629
Practice Address - Country:US
Practice Address - Phone:561-903-1995
Practice Address - Fax:561-997-1246
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst