MEDICARE: MADELINE RAE LEATHERBARROW LBS

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	103K00000X	Behavior Analyst	BH008179	PA

General Provider Information

NPI Number	:	1265390124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE RAE LEATHERBARROW LBS

Provider Business Mailing Address
First Line	:	4954 CABIN RUN RD
Second Line	:
City	:	PIPERSVILLE
State	:	PA
Zip	:	18947-1057
Country	:	US
Telephone Number	:	267-272-9911
Fax Number	:

Provider Business Practice Location Address
First Line	:	1035 VIRGINIA DR
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-3103
Country	:	US
Telephone Number	:	215-718-2102
Fax Number	:	272-400-2026

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

Provider Enumeration Date	:	01/12/2026
Last Update Date	:	01/12/2026

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