Organization
GROWUP
Active
Organization
GROWUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEELA JACKSON PSYD (LICENSED CLINICAL PSYCHOLOGIST)
(267) 273-8041
Entity
Organization
Contact information
Practice address
100 W MAIN ST, SUITE 435, LANSDALE, PA 19446-2019
(267) 273-8041
Mailing address
345 LEVERINGTON AVE, PHILADELPHIA, PA 19128-4738
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PS017033
PA
Other
Enumeration date
11/04/2015
Last updated
11/04/2015
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