Provider Demographics
NPI:1053190942
Name:LEAHY, DIANA (NBC-HWC)
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:LEAHY
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:457 WARBURTON AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-2875
Mailing Address - Country:US
Mailing Address - Phone:267-210-1263
Mailing Address - Fax:
Practice Address - Street 1:457 WARBURTON AVE APT 3
Practice Address - Street 2:
Practice Address - City:HASTINGS ON HUDSON
Practice Address - State:NY
Practice Address - Zip Code:10706-2875
Practice Address - Country:US
Practice Address - Phone:267-210-1263
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
A-3532171171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach