MEDICARE: MARTIN LEICHTMAN 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	296	KS
2	103TC0700X	Clinical Psychologist	071.011161	IL

General Provider Information

NPI Number	:	1700823390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTIN LEICHTMAN PH. D.

Provider Business Mailing Address
First Line	:	3133 BELLWETHER DR
Second Line	:
City	:	AURORA
State	:	IL
Zip	:	60503-3116
Country	:	US
Telephone Number	:	913-961-5226
Fax Number	:

Provider Business Practice Location Address
First Line	:	2272 95TH ST STE 305
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60564-8944
Country	:	US
Telephone Number	:	630-753-9800
Fax Number	:	913-345-1464

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

Provider Enumeration Date	:	06/01/2006
Last Update Date	:	12/10/2024

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Directions to “ MARTIN LEICHTMAN PH. D.” Practice Location

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