Provider Demographics
NPI:1750482337
Name:LEAVY, PATRICIA GAIL (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:GAIL
Last Name:LEAVY
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 1:2829 PARK SQUARE PL
Mailing Address - Street 2:
Mailing Address - City:FERN BCH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-8923
Mailing Address - Country:US
Mailing Address - Phone:904-335-7037
Mailing Address - Fax:904-277-3851
Practice Address - Street 1:2829 PARK SQUARE PL
Practice Address - Street 2:
Practice Address - City:FERN BCH
Practice Address - State:FL
Practice Address - Zip Code:32034-8923
Practice Address - Country:US
Practice Address - Phone:904-335-7037
Practice Address - Fax:904-277-3851
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2025-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDD040ZMedicare PIN