Provider Demographics
NPI:1205487303
Name:JENNIFER LESLIE PSYD LLC
Entity type:Organization
Organization Name:JENNIFER LESLIE PSYD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LESLIE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:978-482-7126
Mailing Address - Street 1:451 ANDOVER ST STE 130
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5070
Mailing Address - Country:US
Mailing Address - Phone:978-482-7126
Mailing Address - Fax:
Practice Address - Street 1:451 ANDOVER ST STE 130
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5070
Practice Address - Country:US
Practice Address - Phone:978-482-7126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)