Provider Demographics
NPI:1902062359
Name:KOEGEL, LESLEY B (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:B
Last Name:KOEGEL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 AVENUE OF THE AMERICAS
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-1205
Mailing Address - Country:US
Mailing Address - Phone:212-255-8182
Mailing Address - Fax:
Practice Address - Street 1:161 AVENUE OF THE AMERICAS
Practice Address - Street 2:5TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-1205
Practice Address - Country:US
Practice Address - Phone:212-255-8182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012786103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool