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General NPI Number Information
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NPI Number | 1700823390
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Entity Type | Individual
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Provider Name | MARTIN LEICHTMAN PH. D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 2272 95TH ST STE 305
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City | NAPERVILLE
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State | IL
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Zip | 60564-8944
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Country | US
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Telephone | 630-753-9800
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Fax | 913-345-1464
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Provider Business Mailing Address
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Address Line | 3133 BELLWETHER DR
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City | AURORA
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State | IL
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Zip | 60503-3116
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Country | US
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Telephone | 913-961-5226
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 296
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.011161
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License Number State | IL
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