Healthcare Provider Details

I. General information

NPI: 1346641925
Provider Name (Legal Business Name): LEILA AUDINOT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 09/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 OLD POST ROAD
RIFTON NY
12471-0385
US

IV. Provider business mailing address

PO BOX 385 1329 OLD POST ROAD
RIFTON NY
12471-0385
US

V. Phone/Fax

Practice location:
  • Phone: 845-658-9644
  • Fax:
Mailing address:
  • Phone: 845-658-9644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: