Healthcare Provider Details

I. General information

NPI: 1952057366
Provider Name (Legal Business Name): LEAH BERENSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2022
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1402 MACLOVIA ST APT F
SANTA FE NM
87505-3283
US

IV. Provider business mailing address

1200 N WHITE SANDS BLVD STE 121
ALAMOGORDO NM
88310-6774
US

V. Phone/Fax

Practice location:
  • Phone: 925-812-0772
  • Fax:
Mailing address:
  • Phone: 866-273-2451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number26024D
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: