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General NPI Number Information
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NPI Number | 1306400833
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Entity Type | Individual
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Provider Name | LEAH CORINNE PETRUCCI MA
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Gender | Female
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Dates
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Enumeration Date | 04/30/2019
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 8421 ISLESWORTH CT APT 14201
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City | SARASOTA
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State | FL
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Zip | 34243-6162
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Country | US
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Telephone | 941-705-0973
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Fax | 941-727-0578
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Provider Business Mailing Address
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Address Line | 8421 ISLESWORTH CT APT 14201
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City | SARASOTA
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State | FL
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Zip | 34243-6162
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Country | US
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Telephone | 941-705-0973
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Fax | 941-727-0578
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 17650
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 17650
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License Number State | FL
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