Healthcare Provider Details

I. General information

NPI: 1598992901
Provider Name (Legal Business Name): LEAH KATHRYN PHANEUF PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2009
Last Update Date: 08/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 EAST GENESEE ST SUITE 130
SYRACUSE NY
13202
US

IV. Provider business mailing address

251 SALINA MEADOWS PKWY SUITE 100
SYRACUSE NY
13212
US

V. Phone/Fax

Practice location:
  • Phone: 315-464-3103
  • Fax: 315-464-3944
Mailing address:
  • Phone: 315-464-2000
  • Fax: 315-464-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number018550
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: