Healthcare Provider Details

I. General information

NPI: 1962985374
Provider Name (Legal Business Name): LEANNE TAYLOR PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 GLADES RD BLDG AZ-79
BOCA RATON FL
33431-6424
US

IV. Provider business mailing address

2901 NE 48TH ST
LIGHTHOUSE POINT FL
33064-7117
US

V. Phone/Fax

Practice location:
  • Phone: 561-297-0502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number10131
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: