Healthcare Provider Details

I. General information

NPI: 1053298000
Provider Name (Legal Business Name): LEAVY PSYCHOLOGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 PARK SQUARE PL
FERN BCH FL
32034-8923
US

IV. Provider business mailing address

2829 PARK SQUARE PL
FERN BCH FL
32034-8923
US

V. Phone/Fax

Practice location:
  • Phone: 904-335-7037
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: PATRICIA G LEAVY
Title or Position: OWNER
Credential: PH.D
Phone: 904-335-7037