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General NPI Number Information
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NPI Number | 1053535526
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Entity Type | Individual
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Provider Name | LESLIE M JOSEPH PH.D
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Gender | Male
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/26/2013
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Provider Practice Location Address
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Address Line | 6901 N 72ND ST
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City | OMAHA
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State | NE
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Zip | 68122-1709
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Country | US
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Telephone | 402-572-2916
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Fax | 402-572-3544
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Provider Business Mailing Address
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Address Line | PO BOX 641130
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City | OMAHA
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State | NE
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Zip | 68164-7130
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Country | US
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Telephone | 402-572-2907
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Fax | 402-572-3544
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 82
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License Number State | NE
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