Healthcare Provider Details

I. General information

NPI: 1871662031
Provider Name (Legal Business Name): LESLIE PEARLMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 W CORDOVA RD
SANTA FE NM
87505-1809
US

IV. Provider business mailing address

325 W CORDOVA RD
SANTA FE NM
87505-1809
US

V. Phone/Fax

Practice location:
  • Phone: 505-474-5504
  • Fax: 505-474-6642
Mailing address:
  • Phone: 505-474-5504
  • Fax: 505-474-6642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0840
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: