=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740473099
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEAH EUGENA BEHL PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2007
-----------------------------------------------------
Last Update Date | 10/03/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 118 HADDON AVE
-----------------------------------------------------
City | HADDONFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08033-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-685-0173
-----------------------------------------------------
Fax | 856-566-6108
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 118 HADDON AVE
-----------------------------------------------------
City | HADDONFIELD
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08033-1717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 856-685-0173
-----------------------------------------------------
Fax | 856-566-2797
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 35SI00442100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------