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General NPI Number Information
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NPI Number | 1265087449
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Entity Type | Organization
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Legal Business Name | DR. LESLIE GAVIN, PH.D. PLLC
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Dates
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Enumeration Date | 08/05/2019
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Last Update Date | 08/05/2019
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Provider Practice Location Address
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Address Line | 1515 S ORLANDO AVE STE M
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City | MAITLAND
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State | FL
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Zip | 32751-6471
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Country | US
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Telephone | 407-701-4516
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Fax |
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Provider Business Mailing Address
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Address Line | 1515 S ORLANDO AVE STE M
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City | MAITLAND
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State | FL
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Zip | 32751-6471
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Country | US
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Telephone | 407-701-4516
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | DR. LESLIE ANN GAVIN DEVITT
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Credential | PH.D.
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Telephone | 407-701-4516
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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 |
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License Number State |
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