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General NPI Number Information
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NPI Number | 1649263765
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Entity Type | Organization
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Legal Business Name | JACK J. LESYK, PH.D., INC.
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 04/29/2008
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Provider Practice Location Address
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Address Line | 21625 CHAGRIN BLVD SUITE 200
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City | BEACHWOOD
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State | OH
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Zip | 44122-5363
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Country | US
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Telephone | 216-575-6175
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Fax | 216-490-0155
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Provider Business Mailing Address
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Address Line | 21625 CHAGRIN BLVD SUITE 200
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City | BEACHWOOD
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State | OH
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Zip | 44122-5363
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Country | US
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Telephone | 216-575-6175
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Fax | 216-490-0155
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACK J. LESYK
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Credential | PH.D.
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Telephone | 216-575-6175
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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 | 1050
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License Number State | OH
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