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General NPI Number Information
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NPI Number | 1750342002
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Entity Type | Individual
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Provider Name | LESLIE KATHRYN MCGOVERN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 03/28/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1001 UNIVERSITY DR
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City | STATE COLLEGE
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State | PA
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Zip | 16801-6600
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Country | US
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Telephone | 814-237-8361
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Fax | 814-234-3572
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Provider Business Mailing Address
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Address Line | 3626 KNARR RD
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City | TYRONE
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State | PA
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Zip | 16686-3518
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Country | US
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Telephone | 814-684-4164
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Fax | 814-234-3572
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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 | PS-008327-L
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License Number State | PA
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