Provider Demographics
NPI:1104859636
Name:DESOLE, LEAH MARION (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:MARION
Last Name:DESOLE
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 1:528 W 111TH ST
Mailing Address - Street 2:SUITE 27
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-1977
Mailing Address - Country:US
Mailing Address - Phone:917-757-5422
Mailing Address - Fax:
Practice Address - Street 1:528 W 111TH ST
Practice Address - Street 2:SUITE 27
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-1977
Practice Address - Country:US
Practice Address - Phone:917-757-5422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015880103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist