Healthcare Provider Details

I. General information

NPI: 1235192477
Provider Name (Legal Business Name): WILLIAM HART LESCHEY III PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 01/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 LANCASTER ST
PORTLAND ME
04101-2406
US

IV. Provider business mailing address

107 DELANO PARK
CAPE ELIZABETH ME
04107-1934
US

V. Phone/Fax

Practice location:
  • Phone: 207-874-1030
  • Fax: 207-874-1044
Mailing address:
  • Phone: 207-799-3813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS1091
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: