Provider Demographics
NPI:1225368020
Name:POPALI-LEHANE, LEELAWATTE (PHD)
Entity Type:Individual
Prefix:
First Name:LEELAWATTE
Middle Name:
Last Name:POPALI-LEHANE
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 1:26029 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1345
Mailing Address - Country:US
Mailing Address - Phone:718-343-5123
Mailing Address - Fax:718-343-5123
Practice Address - Street 1:26029 UNION TPKE
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1345
Practice Address - Country:US
Practice Address - Phone:718-343-5123
Practice Address - Fax:718-343-5123
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017649103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical