Provider Demographics
NPI:1134127780
Name:PEPITONE, LESLIE ANGELICA (PHD)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:ANGELICA
Last Name:PEPITONE
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 1:200 LAWRENCE RD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-3225
Mailing Address - Country:US
Mailing Address - Phone:610-353-8403
Mailing Address - Fax:
Practice Address - Street 1:200 LAWRENCE RD
Practice Address - Street 2:SUITE 700
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-3225
Practice Address - Country:US
Practice Address - Phone:610-353-8403
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-003556-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA427304Medicare ID - Type UnspecifiedPSYCHOLOGIST