Healthcare Provider Details

I. General information

NPI: 1710809421
Provider Name (Legal Business Name): LEORA MITZNER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 BENNER ST
HIGHLAND PARK NJ
08904-2240
US

IV. Provider business mailing address

219 BENNER ST
HIGHLAND PARK NJ
08904-2240
US

V. Phone/Fax

Practice location:
  • Phone: 646-283-2013
  • Fax: 732-745-9780
Mailing address:
  • Phone: 646-283-2013
  • Fax: 732-745-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number790900
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: