Provider Demographics
NPI:1043040322
Name:LEPTIC, MICHAEL (PHD, LPA)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:LEPTIC
Suffix:
Gender:M
Credentials:PHD, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11439 UPPER GEORGES CREEK RD SW
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-3702
Mailing Address - Country:US
Mailing Address - Phone:240-920-6834
Mailing Address - Fax:
Practice Address - Street 1:11439 UPPER GEORGES CREEK RD SW
Practice Address - Street 2:
Practice Address - City:FROSTBURG
Practice Address - State:MD
Practice Address - Zip Code:21532-3702
Practice Address - Country:US
Practice Address - Phone:240-920-6834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-02
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA0946103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist