Active NPI
Leland Reback, PSYD
- Psychologist
- Old Lyme, CT
National Provider Identifier
1053957258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 38326
- Practice address
- 55 Hatchetts Hill Rd
Old Lyme, CT 06371-1534 - Phone
- (800) 370-3651
- NPI assigned
- Nov 22, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 38326 | TX | Primary |
Addresses
Primary practice location
55 Hatchetts Hill Rd
Old Lyme, CT 06371-1534
Mailing address
55 Hatchetts Hill Rd
Old Lyme, CT 06371-1534
Phone (800) 370-3651
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38326 | TX | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1574380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574380800000",
"number": "1053957258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 HATCHETTS HILL RD",
"city": "OLD LYME",
"state": "CT",
"postal_code": "063711534",
"telephone_number": "800-370-3651"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "55 HATCHETTS HILL RD",
"city": "OLD LYME",
"state": "CT",
"postal_code": "063711534",
"telephone_number": "800-370-3651"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REBACK",
"first_name": "LELAND",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-11-22",
"last_updated": "2019-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist",
"state": "TX",
"license": "38326",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Old Lyme, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.