Healthcare Provider Details

I. General information

NPI: 1336013796
Provider Name (Legal Business Name): RUST PSYCHOLOGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2025
Last Update Date: 09/30/2025
Certification Date: 09/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 FLEETWOOD RD
COMMACK NY
11725-1762
US

IV. Provider business mailing address

41 FLEETWOOD RD
COMMACK NY
11725-1762
US

V. Phone/Fax

Practice location:
  • Phone: 631-486-0670
  • Fax:
Mailing address:
  • Phone: 631-486-0670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LEIGH RUST
Title or Position: OWNER/PSYCHOLOGIST
Credential: PSY.D.
Phone: 631-486-0670