Provider Demographics
NPI:1215081948
Name:SITRIN, LEONARD CRAIG (PHD)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:CRAIG
Last Name:SITRIN
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 1:12 HASTINGS CT
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-1379
Mailing Address - Country:US
Mailing Address - Phone:908-722-0260
Mailing Address - Fax:732-356-0507
Practice Address - Street 1:65 MOUNTAIN BLVD.
Practice Address - Street 2:SUITE 210
Practice Address - City:WARREN
Practice Address - State:NJ
Practice Address - Zip Code:07059-5658
Practice Address - Country:US
Practice Address - Phone:732-356-5665
Practice Address - Fax:732-356-0507
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ03450103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical