Provider Demographics
NPI:1003897422
Name:LEIGH, IRENE W (PHD)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:W
Last Name:LEIGH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E 2ND ST
Mailing Address - Street 2:UNIT 203
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-7001
Mailing Address - Country:US
Mailing Address - Phone:240-292-6798
Mailing Address - Fax:
Practice Address - Street 1:210 E 2ND ST
Practice Address - Street 2:UNIT 203
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-7001
Practice Address - Country:US
Practice Address - Phone:240-292-6798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-11
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02840103T00000X
DC1604103T00000X
NY9190103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist