Healthcare Provider Details

I. General information

NPI: 1427754811
Provider Name (Legal Business Name): LEON LOUIS PLITT GELLERT PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2023
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 ELLIOTT AVE
BRYN MAWR PA
19010-3412
US

IV. Provider business mailing address

24 DECATUR RD
HAVERTOWN PA
19083-1412
US

V. Phone/Fax

Practice location:
  • Phone: 917-714-9808
  • Fax:
Mailing address:
  • Phone: 917-714-9808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS018824
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: