Provider Demographics
NPI:1063620714
Name:WHITE, LEANNA S (PHD)
Entity type:Individual
Prefix:DR
First Name:LEANNA
Middle Name:S
Last Name:WHITE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-0081
Mailing Address - Country:US
Mailing Address - Phone:716-672-7377
Mailing Address - Fax:
Practice Address - Street 1:125 FOREST PL
Practice Address - Street 2:
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1701
Practice Address - Country:US
Practice Address - Phone:716-673-3424
Practice Address - Fax:716-673-3140
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002397-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health