Provider Demographics
NPI:1215055603
Name:LEIMKHUHLER, BRETT (PHD)
Entity type:Individual
Prefix:
First Name:BRETT
Middle Name:
Last Name:LEIMKHUHLER
Suffix:
Gender:M
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 69
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02880
Mailing Address - Country:US
Mailing Address - Phone:401-789-7848
Mailing Address - Fax:401-782-2653
Practice Address - Street 1:512 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879
Practice Address - Country:US
Practice Address - Phone:401-789-7848
Practice Address - Fax:401-782-2653
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS335103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410194OtherBCBS RI BLUECHIP PROVIDER
211338OtherBCBS RI PROVIDER ID