Provider Demographics
NPI:1861408445
Name:STERN, LESLIE (PHD)
Entity type:Individual
Prefix:
First Name:LESLIE
Middle Name:
Last Name:STERN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 W 16TH ST
Mailing Address - Street 2:11DS
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-6328
Mailing Address - Country:US
Mailing Address - Phone:212-242-0624
Mailing Address - Fax:
Practice Address - Street 1:85 5TH AVE
Practice Address - Street 2:906
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3019
Practice Address - Country:US
Practice Address - Phone:212-242-0624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8060103TC0700X, 103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01692442Medicaid
NYVM7501Medicare PIN
NY01692442Medicaid