Provider Demographics
NPI:1811332323
Name:LEAHY, LAUREN (ND, LMT)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:
Last Name:LEAHY
Suffix:
Gender:F
Credentials:ND, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 FIGUREA AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10312-3239
Mailing Address - Country:US
Mailing Address - Phone:646-884-2077
Mailing Address - Fax:
Practice Address - Street 1:641 INGRAM AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314
Practice Address - Country:US
Practice Address - Phone:646-884-2077
Practice Address - Fax:718-556-5362
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT099.0082155175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath