Provider Demographics
NPI:1023251931
Name:LEIPHART, LINDA (PSYD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:
Last Name:LEIPHART
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 BRIDGEPORT AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SHELTON
Mailing Address - State:CT
Mailing Address - Zip Code:06484-4622
Mailing Address - Country:US
Mailing Address - Phone:203-929-4774
Mailing Address - Fax:203-929-4778
Practice Address - Street 1:1077 BRIDGEPORT AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4622
Practice Address - Country:US
Practice Address - Phone:203-929-4774
Practice Address - Fax:203-929-4778
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002605103TB0200X, 103TC0700X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060002605CT03OtherANTHEM BLUE CROSS BLUE SHIELD
CT61-40942OtherCONNECTICARE
TX7090679OtherAETNA
PA2223663OtherCIGNA
KY7090679OtherAETNA
CTP3894525OtherOXFORD HEALTH PLAN
KY350879OtherHEALTHNET
NY556641OtherVALUE OPTIONS BEHAVIORAL
GA760842957OtherUNITED HEALTHCARE