Provider Demographics
NPI:1265648430
Name:LEBARON, LESLEY (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLEY
Middle Name:
Last Name:LEBARON
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 1:4040 NW 33RD PL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-6156
Mailing Address - Country:US
Mailing Address - Phone:352-373-1004
Mailing Address - Fax:
Practice Address - Street 1:3669 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2856
Practice Address - Country:US
Practice Address - Phone:352-373-1004
Practice Address - Fax:352-373-2803
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH3266101YM0800X
FLMT1856106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist