Provider Demographics
NPI:1235252255
Name:RHINEHART, LESLIE LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:LYNN
Last Name:RHINEHART
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 W CORYDON ST
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-3907
Mailing Address - Country:US
Mailing Address - Phone:814-368-7677
Mailing Address - Fax:
Practice Address - Street 1:143 PLEASANT DR
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-3371
Practice Address - Country:US
Practice Address - Phone:814-726-3310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003832L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q18964Medicare UPIN
RH080719Medicare ID - Type Unspecified