Provider Demographics
NPI:1194805986
Name:LEUTE, GEORGE M III
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:M
Last Name:LEUTE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 E SECOND ST
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2905
Mailing Address - Country:US
Mailing Address - Phone:610-891-9077
Mailing Address - Fax:610-891-9884
Practice Address - Street 1:19 E SECOND ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2905
Practice Address - Country:US
Practice Address - Phone:610-891-9077
Practice Address - Fax:610-891-9884
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004523L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No103T00000XBehavioral Health & Social Service ProvidersPsychologist