Healthcare Provider Details

I. General information

NPI: 1134324106
Provider Name (Legal Business Name): DR ROBERT L LEAHY PSYCHOLOGIST PC DBA AMERICAN INSTITUTE FOR COGNITIV
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 EAST 57TH STREET SUITE 1101
NEW YORK NY
10022-2962
US

IV. Provider business mailing address

136 EAST 57TH STREET SUITE 1101
NEW YORK NY
10022-2962
US

V. Phone/Fax

Practice location:
  • Phone: 212-308-2440
  • Fax: 212-308-3099
Mailing address:
  • Phone: 212-308-2440
  • Fax: 212-308-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number73341
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number73341
License Number StateNY

VIII. Authorized Official

Name: DR. ROBERT L LEAHY
Title or Position: DIRECTOR
Credential: PHD
Phone: 212-308-2440