MEDICARE: DR. LESLIE CASE PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	001215	CT

General Provider Information

NPI Number	:	1073785564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE CASE PHD

Provider Business Mailing Address
First Line	:	46 SOUTH QUAKER LANE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1637
Country	:	US
Telephone Number	:	860-523-5188
Fax Number	:

Provider Business Practice Location Address
First Line	:	46 SOUTH QUAKER LANE
Second Line	:
City	:	WEST HARTFORD
State	:	CT
Zip	:	06119-1637
Country	:	US
Telephone Number	:	860-523-5188
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/25/2008
Last Update Date	:	03/25/2008

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