Provider Demographics
NPI:1861556672
Name:LEACH, SHARON (PHD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:LEACH
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 1:135 ALLEN BROOK LN
Mailing Address - Street 2:
Mailing Address - City:WILLISTON
Mailing Address - State:VT
Mailing Address - Zip Code:05495-9209
Mailing Address - Country:US
Mailing Address - Phone:802-878-2332
Mailing Address - Fax:802-878-0230
Practice Address - Street 1:135 ALLEN BROOK LN
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:VT
Practice Address - Zip Code:05495-9209
Practice Address - Country:US
Practice Address - Phone:802-878-2332
Practice Address - Fax:802-878-0230
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT848103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1013079Medicaid