Active NPI
Jerry Patrick Leahy, PH.D.
- Clinical Psychologist
- Roanoke, VA
National Provider Identifier
1194782813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810001232
- Practice address
- 3371 Melody Ave
Roanoke, VA 24018-3115 - Phone
- (540) 772-0661
- NPI assigned
- Apr 27, 2006
- Last updated
- Sep 21, 2007
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810001232 | VA | Primary |
Addresses
Primary practice location
3371 Melody Ave
Roanoke, VA 24018-3115
Mailing address
3371 Melody Ave
Roanoke, VA 24018-3115
Phone (540) 772-0661
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810001232 | VA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190332800000",
"number": "1194782813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3371 MELODY AVE",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240183115",
"telephone_number": "540-772-0661"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3371 MELODY AVE",
"city": "ROANOKE",
"state": "VA",
"postal_code": "240183115",
"telephone_number": "540-772-0661"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEAHY",
"first_name": "JERRY",
"middle_name": "PATRICK",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-27",
"last_updated": "2007-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810001232",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Roanoke, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.