MEDICARE: DR. KATHERINE H. LEDDICK PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	012830	NY

General Provider Information

NPI Number	:	1023183704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE H. LEDDICK PH.D.

Provider Business Mailing Address
First Line	:	259 W 132ND ST APT 1
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10027-7966
Country	:	US
Telephone Number	:	917-816-2621
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 5TH AVE RM 1915
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10016-6601
Country	:	US
Telephone Number	:	917-816-2521
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	08/01/2022

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