Provider Demographics
NPI:1912345489
Name:DITTERLIZZI, LEYLA I (MS CASAC)
Entity Type:Individual
Prefix:MS
First Name:LEYLA
Middle Name:I
Last Name:DITTERLIZZI
Suffix:
Gender:F
Credentials:MS CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 PEMART AVE
Mailing Address - Street 2:N/A
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2213
Mailing Address - Country:US
Mailing Address - Phone:914-329-1213
Mailing Address - Fax:
Practice Address - Street 1:965 PEMART AVE
Practice Address - Street 2:N/A
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2213
Practice Address - Country:US
Practice Address - Phone:914-329-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY17228101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)