Provider Demographics
NPI:1306400833
Name:PETRUCCI, LEAH CORINNE (MA)
Entity type:Individual
Prefix:MS
First Name:LEAH
Middle Name:CORINNE
Last Name:PETRUCCI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8421 ISLESWORTH CT APT 14201
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34243-6162
Mailing Address - Country:US
Mailing Address - Phone:941-705-0973
Mailing Address - Fax:941-727-0578
Practice Address - Street 1:8421 ISLESWORTH CT APT 14201
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-6162
Practice Address - Country:US
Practice Address - Phone:941-705-0973
Practice Address - Fax:941-727-0578
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-30
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17650101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)