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General NPI Number Information
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NPI Number | 1174735765
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Entity Type | Individual
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Provider Name | LESLIE ANN DELLENBARGER PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 231 BRUTON STREET
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City | BAINBRIDGE
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State | GA
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Zip | 39818
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Country | US
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Telephone | 229-248-1625
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Fax |
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Provider Business Mailing Address
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Address Line | 231 BRUTON STREET P.O. BOX 7851
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City | BAINBRIDGE
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State | GA
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Zip | 39818
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Country | US
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Telephone | 229-248-1625
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY0002466
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY5308
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License Number State | FL
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