Individual
LELAND REBACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSYD
Contact information
Practice address
55 HATCHETTS HILL RD, OLD LYME, CT 06371-1534
(800) 370-3651
Mailing address
55 HATCHETTS HILL RD, OLD LYME, CT 06371-1534
(800) 370-3651
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
38326
TX
Other
Enumeration date
11/22/2019
Last updated
11/22/2019
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