Provider Demographics
NPI:1548578636
Name:FROMM, LEAH D (NPP, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:LEAH
Middle Name:D
Last Name:FROMM
Suffix:
Gender:F
Credentials:NPP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 WILLOW POND WAY STE 201
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526-2687
Mailing Address - Country:US
Mailing Address - Phone:585-454-9662
Mailing Address - Fax:585-735-4646
Practice Address - Street 1:21 WILLOW POND WAY STE 201
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526-2687
Practice Address - Country:US
Practice Address - Phone:585-454-9662
Practice Address - Fax:585-735-4646
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY402022363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health