Provider Demographics
NPI:1962991190
Name:DEMBITZER, LEAH (PSYD)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:
Last Name:DEMBITZER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2315
Mailing Address - Country:US
Mailing Address - Phone:732-806-1641
Mailing Address - Fax:
Practice Address - Street 1:279 VAN BUREN AVE N
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-2357
Practice Address - Country:US
Practice Address - Phone:732-806-1641
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2019-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100590700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist