Provider Demographics
NPI:1003345596
Name:LESKOVAC, BRIAN JASON (MA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:JASON
Last Name:LESKOVAC
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689 N HERMITAGE RD STE 4
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-3237
Mailing Address - Country:US
Mailing Address - Phone:724-983-1940
Mailing Address - Fax:
Practice Address - Street 1:689 N HERMITAGE RD STE 4
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-3237
Practice Address - Country:US
Practice Address - Phone:724-983-1940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012145101YP2500X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health