Provider Demographics
NPI:1891269866
Name:LEAHY, DEBORAH JEAN (RN, LMHC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:JEAN
Last Name:LEAHY
Suffix:
Gender:F
Credentials:RN, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23291 MOORHEAD AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-2555
Mailing Address - Country:US
Mailing Address - Phone:941-204-9038
Mailing Address - Fax:
Practice Address - Street 1:18501 MURDOCK CIR STE 104
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-4002
Practice Address - Country:US
Practice Address - Phone:941-204-9038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2023-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH16569101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty