Provider Demographics
NPI:1023201704
Name:LECK, PAMELA ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:ANN
Last Name:LECK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 5TH AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5010
Mailing Address - Country:US
Mailing Address - Phone:917-385-2341
Mailing Address - Fax:
Practice Address - Street 1:347 5TH AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-5010
Practice Address - Country:US
Practice Address - Phone:917-385-2341
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-24
Last Update Date:2007-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015062103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical