Healthcare Provider Details

I. General information

NPI: 1164805107
Provider Name (Legal Business Name): REBECCA JILL LEITMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 GREENLAWN RD
AMAWALK NY
10501-1504
US

IV. Provider business mailing address

33 GREENLAWN RD
AMAWALK NY
10501-1504
US

V. Phone/Fax

Practice location:
  • Phone: 914-471-5610
  • Fax:
Mailing address:
  • Phone: 914-471-5610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14154
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number095059-01
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60389096
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: