MEDICARE: LSL PSYCHOLOGICAL SERVICES, P.A.

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

General Provider Information

NPI Number	:	1811371040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LSL PSYCHOLOGICAL SERVICES, P.A.

Provider Business Mailing Address
First Line	:	4044 BEACON AVE
Second Line	:
City	:	MONROE
State	:	NC
Zip	:	28110-9826
Country	:	US
Telephone Number	:	228-265-5144
Fax Number	:	228-233-3693

Provider Business Practice Location Address
First Line	:	1508 GOVERNMENT ST
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-3826
Country	:	US
Telephone Number	:	228-265-5144
Fax Number	:	228-233-3693

Authorized Official
Title or Position	:	PSYCHOLOGIST/OWNER
Name	:	DR. LEAH SHARON LEVENSON
Credential	:	PSY.D.
Telephone Number	:	228-265-5144

Provider Enumeration Date	:	07/17/2015
Last Update Date	:	02/23/2023

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