Provider Demographics
NPI:1316034127
Name:AUSTIN, LESLIE E (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:E
Last Name:AUSTIN
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 1:67 E 11TH ST #515
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4616
Mailing Address - Country:US
Mailing Address - Phone:212-460-9177
Mailing Address - Fax:212-353-3188
Practice Address - Street 1:67 E 11TH ST #515
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4616
Practice Address - Country:US
Practice Address - Phone:212-460-9177
Practice Address - Fax:212-353-3188
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000594-1103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis