MEDICARE: LEAH KRISHNA PSY 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	024677	NY

General Provider Information

NPI Number	:	1295564540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH KRISHNA PSY D

Provider Business Mailing Address
First Line	:	29 SANDROCK AVE
Second Line	:
City	:	DOBBS FERRY
State	:	NY
Zip	:	10522-1513
Country	:	US
Telephone Number	:	267-664-8600
Fax Number	:

Provider Business Practice Location Address
First Line	:	520 WHITE PLAINS RD STE 500
Second Line	:
City	:	TARRYTOWN
State	:	NY
Zip	:	10591-5118
Country	:	US
Telephone Number	:	914-586-2204
Fax Number	:

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

Provider Enumeration Date	:	07/26/2024
Last Update Date	:	11/06/2024

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