Provider Demographics
NPI:1962160341
Name:BARDA LEAVITT PH.D. PLLC
Entity type:Organization
Organization Name:BARDA LEAVITT PH.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BARDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:207-622-3559
Mailing Address - Street 1:PO BOX 5272
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04332-5272
Mailing Address - Country:US
Mailing Address - Phone:207-622-3559
Mailing Address - Fax:
Practice Address - Street 1:2 BEECH ST UNIT 1A
Practice Address - Street 2:
Practice Address - City:HALLOWELL
Practice Address - State:ME
Practice Address - Zip Code:04347-1520
Practice Address - Country:US
Practice Address - Phone:207-622-3559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)