Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | ||
N | 103TC0700X | Clinical Psychologist | ||
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | ||
N | 103TB0200X | Cognitive & Behavioral Psychologist | 021969 | NY |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | 021969-1 | NY |
N | 103G00000X | Clinical Psychologist | 35SI00528100 | NJ |
N | 103TC0700X | Clinical Psychologist | 35SI00528100 | NJ |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | ||
N | 103TH0004X | Health Psychologist | ||
N | 103TP2701X | Group Psychotherapist |
NPI | 1578001632 |
---|---|
Provider Name | Dr. Theresa Maria Leyro |
First Address | Greenwich, CT 06830-6927 |
Second Address | Greenwich, CT 06830-6927 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2017 |
Last Update Date | 16/02/2021 |