Healthcare Provider Details

I. General information

NPI: 1023251931
Provider Name (Legal Business Name): LINDA LEIPHART PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2009
Last Update Date: 04/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1077 BRIDGEPORT AVE SUITE 203
SHELTON CT
06484-4622
US

IV. Provider business mailing address

1077 BRIDGEPORT AVE SUITE 203
SHELTON CT
06484-4622
US

V. Phone/Fax

Practice location:
  • Phone: 203-929-4774
  • Fax: 203-929-4778
Mailing address:
  • Phone: 203-929-4774
  • Fax: 203-929-4778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number002605
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number002605
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number002605
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: