MEDICARE: NEW LEAF BEHAVIORAL HEALTH

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1720313778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW LEAF BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	3725 NATIONAL DR
Second Line	:	SUITE 220
City	:	RALEIGH
State	:	NC
Zip	:	27612-4879
Country	:	US
Telephone Number	:	919-781-8370
Fax Number	:

Provider Business Practice Location Address
First Line	:	3725 NATIONAL DR
Second Line	:	SUITE 220
City	:	RALEIGH
State	:	NC
Zip	:	27612-4879
Country	:	US
Telephone Number	:	919-781-8370
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	PATRICK MALLOY
Credential	:
Telephone Number	:	919-781-8370

Provider Enumeration Date	:	10/08/2009
Last Update Date	:	12/27/2011

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Directions to “NEW LEAF BEHAVIORAL HEALTH ” Practice Location

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