1023251931 NPI number — DR. LINDA LEIPHART PSYD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023251931 NPI number — DR. LINDA LEIPHART PSYD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

LEIPHART

Provider First Name:

LINDA

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

PSYD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1023251931

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/08/2009

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1077 BRIDGEPORT AVE

Provider Second Line Business Mailing Address:

SUITE 203

Provider Business Mailing Address City Name:

SHELTON

Provider Business Mailing Address State Name:

CT

Provider Business Mailing Address Postal Code:

06484-4622

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

203-929-4774

Provider Business Mailing Address Fax Number:

203-929-4778

Provider First Line Business Practice Location Address:

1077 BRIDGEPORT AVE

Provider Second Line Business Practice Location Address:

SUITE 203

Provider Business Practice Location Address City Name:

SHELTON

Provider Business Practice Location Address State Name:

CT

Provider Business Practice Location Address Postal Code:

06484-4622

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

203-929-4774

Provider Business Practice Location Address Fax Number:

203-929-4778

Provider Enumeration Date:

04/08/2009

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 103TB0200X , with the licence number:  002605 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 103TC0700X , with the licence number: 002605 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 103TP2701X , with the licence number: 002605 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 060002605CT03 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 61-40942 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 7090679 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 2223663 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
• Identifier: 7090679 . This is a "AETNA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: P3894525 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
• Identifier: 350879 . This is a "HEALTHNET" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
• Identifier: 556641 . This is a "VALUE OPTIONS BEHAVIORAL" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 760842957 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".