Healthcare Provider Details

I. General information

NPI: 1710736830
Provider Name (Legal Business Name): ELANA LEIBOVITCH PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2024
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date: 05/13/2024
Reactivation Date: 06/27/2024

III. Provider practice location address

1190 WINTERSON RD STE 160
LINTHICUM MD
21090-2245
US

IV. Provider business mailing address

534 E CLEMENT ST
BALTIMORE MD
21230-4719
US

V. Phone/Fax

Practice location:
  • Phone: 410-684-3806
  • Fax:
Mailing address:
  • Phone: 954-644-9434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number07462
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: