Provider Demographics
NPI:1073821823
Name:SHRALOW, LESLIE PARKES
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:PARKES
Last Name:SHRALOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:893 N BUCKNELL ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-1934
Mailing Address - Country:US
Mailing Address - Phone:267-886-9607
Mailing Address - Fax:
Practice Address - Street 1:893 N BUCKNELL ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-1934
Practice Address - Country:US
Practice Address - Phone:267-886-9607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008412L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical