Healthcare Provider Details

I. General information

NPI: 1992869275
Provider Name (Legal Business Name): JEANMARIE LEITCH PHD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 10/23/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 CENTENNIAL AVE SUITE 1100
PISCATAWAY NJ
08854-3907
US

IV. Provider business mailing address

671 HOES LN W
PISCATAWAY NJ
08854-8021
US

V. Phone/Fax

Practice location:
  • Phone: 732-235-5000
  • Fax:
Mailing address:
  • Phone: 732-235-5900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004098
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00473600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: