Healthcare Provider Details

I. General information

NPI: 1750482337
Provider Name (Legal Business Name): PATRICIA GAIL LEAVY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
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: 904-277-3851
Mailing address:
  • Phone: 904-335-7037
  • Fax: 904-277-3851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY0004800
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: