MEDICARE: DR. LESLIE VAN BUREN WAITE JR. PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	023836	NY

General Provider Information

NPI Number	:	1558910208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE VAN BUREN WAITE JR. PSY.D.

Provider Business Mailing Address
First Line	:	6 CHESTNUT ST
Second Line	:
City	:	CASTLETON ON HUDSON
State	:	NY
Zip	:	12033-1506
Country	:	US
Telephone Number	:	518-414-5563
Fax Number	:

Provider Business Practice Location Address
First Line	:	6 CHESTNUT ST
Second Line	:
City	:	CASTLETON ON HUDSON
State	:	NY
Zip	:	12033-1506
Country	:	US
Telephone Number	:	518-414-5563
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2019
Last Update Date	:	02/26/2026

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