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General NPI Number Information
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NPI Number | 1497207211
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Entity Type | Individual
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Provider Name | LESLIE LANGE PH.D.
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Gender | Female
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 03/08/2025
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Provider Practice Location Address
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Address Line | 604 MONTEREY AVE
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City | PELHAM
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State | NY
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Zip | 10803-2514
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Country | US
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Telephone | 818-657-9487
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Fax |
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Provider Business Mailing Address
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Address Line | 604 MONTEREY AVE
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City | PELHAM
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State | NY
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Zip | 10803-2514
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Country | US
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Telephone | 818-657-9487
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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 | PSY12673
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License Number State | CA
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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 | 022683
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 003655
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License Number State | CT
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