Healthcare Provider Details

I. General information

NPI: 1316034127
Provider Name (Legal Business Name): LESLIE E. AUSTIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 E 11TH ST #515
NEW YORK NY
10003-4616
US

IV. Provider business mailing address

67 E 11TH ST #515
NEW YORK NY
10003-4616
US

V. Phone/Fax

Practice location:
  • Phone: 212-460-9177
  • Fax: 212-353-3188
Mailing address:
  • Phone: 212-460-9177
  • Fax: 212-353-3188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License Number000594-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: