Provider Demographics
NPI:1720121197
Name:LEIDERMAN, LEONARDO M (PSYD,ABPP)
Entity Type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:M
Last Name:LEIDERMAN
Suffix:
Gender:M
Credentials:PSYD,ABPP
Other - Prefix:DR
Other - First Name:LEO
Other - Middle Name:M
Other - Last Name:LEIDERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD,ABPP
Mailing Address - Street 1:8 LOWER SALEM RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10590-1215
Mailing Address - Country:US
Mailing Address - Phone:914-925-5357
Mailing Address - Fax:914-925-5169
Practice Address - Street 1:275 NORTH ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528-1524
Practice Address - Country:US
Practice Address - Phone:914-925-5357
Practice Address - Fax:914-925-5169
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013117103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical