Healthcare Provider Details

I. General information

NPI: 1386946069
Provider Name (Legal Business Name): LEAH JEAN RENO PATTERSON NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH JEAN PATTERSON NP PMHNP

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 04/10/2024
Certification Date: 04/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 E 23RD ST
NEW YORK NY
10010-4408
US

IV. Provider business mailing address

1300 S FARMVIEW DR APT C31
DOVER DE
19904-3386
US

V. Phone/Fax

Practice location:
  • Phone: 664-650-5337
  • Fax: 646-871-6820
Mailing address:
  • Phone: 302-883-2134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberL8-0000146
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number401804
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: