MEDICARE: DR. LESLIE ALAN FIFERMAN PH.D.

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	103TC0700X	Clinical Psychologist	365	SD

General Provider Information

NPI Number	:	1972532026
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE ALAN FIFERMAN PH.D.

Provider Business Mailing Address
First Line	:	1501 E CENTRE ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57703-3003
Country	:	US
Telephone Number	:	605-787-4205
Fax Number	:

Provider Business Practice Location Address
First Line	:	1501 E CENTRE ST
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57703-3003
Country	:	US
Telephone Number	:	605-787-4205
Fax Number	:

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

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	07/09/2007

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