Leandrea Detheridge
Individual provider Active NPI Behavior Technician · White Marsh, MD
NPI 1497570097 · NPPES record last updated Nov 19, 2024
Key facts
- NPI
- 1497570097
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 10839 Philadelphia Rd Ste B
White Marsh, MD 21162-1717 - Phone
- (240) 751-7105
- NPI assigned
- Nov 19, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
10839 Philadelphia Rd Ste B
White Marsh, MD 21162-1717
Mailing address
10839 Philadelphia Rd Ste B
White Marsh, MD 21162-1717
Phone (240) 751-7105
Other providers in White Marsh, MD
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- Tracy Cudjoe
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- Abiola O Dada
- Rodel Dapul
- Cynthia Marie Faherty
- Marianne L Fingerhood
- Taylor Garrett
- Gober Chiropractic Centers Inc
- Timothy Gober
All providers in White Marsh, MD · Behavior Technician in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 19, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.