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General NPI Number Information
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NPI Number | 1881905933
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Entity Type | Individual
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Provider Name | LESLIE JUNE YERACE PSYD
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Gender | Female
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | 353 N DUFFY RD
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City | BUTLER
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State | PA
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Zip | 16001-1138
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Country | US
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Telephone | 724-285-2510
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Fax |
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Provider Business Mailing Address
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Address Line | 3298 CONWAY WALLROSE RD
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City | BADEN
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State | PA
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Zip | 15005-2314
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Country | US
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Telephone | 412-722-6205
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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 | PS016817
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License Number State | PA
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