Healthcare Provider Details

I. General information

NPI: 1790763845
Provider Name (Legal Business Name): LEAH GREENWOOD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2006
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 W LINCOLN HWY
EXTON PA
19341-2547
US

IV. Provider business mailing address

506 EXTON CMNS
EXTON PA
19341-2452
US

V. Phone/Fax

Practice location:
  • Phone: 610-873-2233
  • Fax: 610-873-2235
Mailing address:
  • Phone: 610-214-2090
  • Fax: 610-214-2091

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS008758L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0017336770003
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier2149091000
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPERSONAL CHOICE
# 3
Identifier001662198
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerHIGHMARK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: