Healthcare Provider Details

I. General information

NPI: 1083008312
Provider Name (Legal Business Name): JUDYTH A. LEAVITT PSYCHOTHERAPIST P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2015
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7015 SPRING RD
SHERMANS DALE PA
17090-8121
US

IV. Provider business mailing address

7015 SPRING RD
SHERMANS DALE PA
17090-8121
US

V. Phone/Fax

Practice location:
  • Phone: 603-903-2122
  • Fax: 717-275-0249
Mailing address:
  • Phone: 603-903-2122
  • Fax: 717-275-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0631
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1514
License Number StateNH

VIII. Authorized Official

Name: JUDYTH A LEAVITT
Title or Position: CEO
Credential:
Phone: 603-903-2122