Provider Demographics
NPI:1992869275
Name:LEITCH, JEANMARIE (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:JEANMARIE
Middle Name:
Last Name:LEITCH
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:671 HOES LN W
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-8021
Mailing Address - Country:US
Mailing Address - Phone:732-235-5900
Mailing Address - Fax:
Practice Address - Street 1:151 CENTENNIAL AVE
Practice Address - Street 2:SUITE 1100
Practice Address - City:PISCATAWAY
Practice Address - State:NJ
Practice Address - Zip Code:08854-3907
Practice Address - Country:US
Practice Address - Phone:732-235-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701004098101YP2500X
NJ37PC00473600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004945247Medicaid
VA004945247Medicaid
VAC02810Medicare ID - Type Unspecified