Provider Demographics
NPI:1902264096
Name:LEITER, BETTY A
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:A
Last Name:LEITER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 S MAIN ST
Mailing Address - Street 2:1-C
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-3978
Mailing Address - Country:US
Mailing Address - Phone:410-836-0820
Mailing Address - Fax:
Practice Address - Street 1:336 S MAIN ST
Practice Address - Street 2:1-C
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3978
Practice Address - Country:US
Practice Address - Phone:410-836-0820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2016-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6354101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional